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Chapter 19 - Intrauterine Growth Restriction

from Section 3 - Fetal Medicine

Published online by Cambridge University Press:  20 November 2021

Tahir Mahmood
Affiliation:
Victoria Hospital, Kirkcaldy
Charles Savona Ventura
Affiliation:
University of Malta, Malta
Ioannis Messinis
Affiliation:
University of Thessaly, Greece
Sambit Mukhopadhyay
Affiliation:
Norfolk & Norwich University Hospital, UK
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Summary

Intrauterine growth restriction (IUGR) refers to diminished fetal growth during intrauterine life and is defined as decreased fetal growth. However, what needs to be clarified is that IUGR does not refer to just small fetal size, but to smaller size than what this particular fetus was genetically programmed to be. So IUGR refers to a fetus that is genetically programmed to reach a specific weight, but for some reason it fails to reach this weight. There is generally a main underlying pathological cause that is responsible for this clinical condition, such as genetic or environmental factors [1]. IUGR is a common obstetric complication that remains a leading cause of neonatal and fetal mortality and morbidity. It alters the antenatal care regimen, increasing antenatal visits, ultrasound examinations and admissions to the hospital. The incidence of IUGR varies from 7–24% in different studies and this broad range reflects, on one hand, the multifactorial nature of IUGR and, on the other hand, it results from the lack of a homogenous universal definition, something that leads to different diagnostic criteria being used antenatally and, as a result, different detection rates. As mentioned, IUGR refers to a decrease in the rhythm of fetal growth, caused usually by underlying pathological reasons, so that the fetus is unable to reach its growth potential, making the IUGR fetus at risk of developing complications such as fetal hypoxia and acidosis. There are ethnic, racial and individualized variations that must be taken into account when examining a fetus before classifying it as IUGR. A diagnosis of IUGR is classically made antenatally; however, in some cases the diagnosis is made only after birth, especially in pregnancies with poor or complete lack of antenatal care. Prompt recognition of IUGR fetuses is of utmost importance, as there is an increased risk of perinatal morbidity and mortality. Identification and appropriate management of these cases can reduce this risk and improve their outcome [2–4].

Type
Chapter
Information
The EBCOG Postgraduate Textbook of Obstetrics & Gynaecology
Obstetrics & Maternal-Fetal Medicine
, pp. 158 - 166
Publisher: Cambridge University Press
Print publication year: 2021

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