IUGRor iintrauterine growth restriction is a condition that causes stunted fetal growth. IUGR is characterized by the size and weight of the fetus that does not match the gestational age.
IUGR is caused by various things. One of the most common causes is an abnormality of the placenta, which is the organ that delivers blood that contains food and oxygen to the baby while in the womb. Disorders and abnormalities in the placenta will cause disruption of fetal growth.
IUGR must be distinguished from low birth weight infants. Although IUGR can cause babies to be born with low body weight, not all babies with low birth weight experience IUGR.
To find out whether the fetus is experiencing growth delays, it is necessary to calculate gestational age (the age of the fetus in the womb) accurately and periodic ultrasound examinations.
In general, there are 2 types of IUGR, namely:
- Symmetrical IUGRFetal growth in this condition is stunted with the size of each body part being proportional. This means that all parts of the fetal body that have IUGR are small, including the size of the internal organs.
- Asymmetric IUGRFetal growth in this condition is stunted with disproportionate body size. When experiencing asymmetric IUGR, one part of the fetal body, such as the head size can be normal and according to gestational age, but the other body parts are smaller.
Causes of IUGR
IUGR is most often caused by a disruption or abnormality in the placenta. The placenta is an organ that supplies blood containing oxygen and nutrients from pregnant women to the fetus, and removes metabolic waste from the fetus.
Disorders and abnormalities in the placenta will cause disruption of the supply of oxygen and nutrients to the fetus. This will inhibit fetal growth.
The risk of IUGR will increase if pregnant women experience the following conditions:
- Uncontrolled diabetes mellitus
- High blood pressure (hypertension)
- Preeclampsia
- Heart disease
- Kidney illness
- Lung disease
- Anemia
- Infections, such as rubella, cytomegalovirus, toxoplasmosis, and syphilis
- Malnutrition during pregnancy
- Smoking, alcoholism, or using drugs
Congenital abnormalities in the fetus, such as Down's syndrome, Fanconi's syndrome, anencephaly, and multiple pregnancies, can also increase the risk of IUGR.
Symptoms and Signs of IUGR
IUGR causes stunted fetal growth. Pregnant women who carry a fetus with IUGR do not necessarily feel specific complaints and symptoms. However, the size of the stomach may be smaller when compared to a pregnancy with a normally growing fetus.
The main sign of IUGR is the smaller size of the fetus compared to its gestational age. This measure includes the estimated weight, body length, and head circumference measurements. IUGR fetuses generally have an estimated weight below the 10th percentile for gestational age.
When to go to the doctor
As described above, IUGR has no symptoms. Every pregnant woman is obliged to carry out routine pregnancy check-ups to determine the condition of her pregnancy and monitor the growth and development of the fetus.
Every pregnant woman needs to regularly check her pregnancy to the doctor. Below is a detailed schedule of regular check-ups to the doctor that pregnant women need to do:
- 4th to 28th week: once a month
- 28th to 36th week: every 2 weeks
- 36th to 40th week: once a week
If pregnant women have health conditions or habits that increase the risk of IUGR, such as suffering from diabetes, hypertension, preeclampsia, malnutrition, smoking, and alcoholism, regular check-ups are mandatory to control these diseases and conditions.
If the fetus has IUGR, follow the recommendations and schedule of examinations given by the doctor. It is intended that the development of the condition of pregnant women and fetuses can be monitored and complications due to IUGR can be prevented.
Diagnosis of IUGR
IUGR is detected when pregnant women go to a doctor for prenatal check-ups. The doctor will ask questions about complaints that occur during pregnancy, the history of the disease that the pregnant woman has, the diet, and the lifestyle of the pregnant woman.
Next, the doctor will conduct an examination to determine the condition of the pregnant woman and assess whether the fetal growth is normal or stunted. Some of the types of checks that will be carried out are:
- Weight measurementThe goal is to detect malnutrition in pregnant women. If the pregnant woman does not gain weight, it could indicate a problem with the pregnancy, including IUGR.
- Fundal height measurementThe goal is to assess the estimated weight of the fetus by calculating the distance from the pubic bone to the top of the uterus. Uterine fundal height that is not in accordance with gestational age indicates an abnormality.
- Ultrasound examinationThe aim is to assess the estimated weight of the fetus and the amount or level of amniotic fluid, and to find out whether the fetus is growing normally and according to gestational age or not.
- Doppler examinationThe goal is to check placental blood flow and blood vessels in the fetal brain. This examination can detect fetal blood flow disturbances, which can identify the possibility of IUGR.
- Amniocentesis examinationAmniocentesis aims to detect abnormalities in the fetus that can cause IUGR. This procedure is done by taking a sample of amniotic fluid for further analysis in the laboratory.
IUGR Treatment
IUGR treatment is based on the cause, condition of the fetus, and gestational age. To assess the development of the fetus, the doctor will perform routine pregnancy tests and ultrasound. There are several ways that doctors will do to treat IUGR, including:
Regulating diet and nutritional intake
If the pregnant woman does not gain weight or if the pregnant woman is malnourished, it will be necessary to improve the diet and fulfill the nutritional intake. Improvements in diet are expected to increase the weight of pregnant women and help overcome IUGR experienced by the fetus.
Enough rest
Doctors will advise pregnant women to rest. Rest can be done at home or in the hospital, this depends on the condition of the pregnant woman. Rest can help increase blood circulation to the fetus, so the fetus can grow properly.
Labor induction
If IUGR occurs at 34 weeks of gestation, doctors recommend speeding up labor by induction. If the gestational age is less than 34 weeks, the doctor will monitor the condition of the fetus until it is 34 weeks.
Caesarean section
A cesarean section may be performed if the pressure from the birth canal during normal delivery is deemed too risky for the fetus.
Complications of IUGR
Complications of IUGR can occur in the fetus and pregnant women. Pregnant women who carry babies with IUGR are at risk for giving birth by caesarean section. Meanwhile, babies born with IUGR are at risk for complications such as:
- Low levels of oxygen in the blood at birth
- Hypothermia (low body temperature)
- Hypoglycemia (low blood sugar)
- Infection
- Abnormal blood cell count
- Difficult to gain weight
- Respiratory system disorders
- Nervous system disorders
- Digestive system disorders
- Cerebral palsy
- Blindness
- Deaf
- Delayed motor development
- Sudden infant death syndrome
IUGR Prevention
IUGR can occur in healthy mothers. To prevent and reduce the risk of IUGR, pregnant women can take the following steps:
- Eat nutritious foods, such as fish, pasteurized milk and dairy products, vegetables and fruits
- Taking prenatal vitamins, such as folic acid, is good for consumption since planning pregnancy and during pregnancy
- Exercise regularly to improve circulation and increase oxygen flow to the fetus. Sports that are safe to do include swimming, yoga, or walking.
- Do not take drugs carelessly. Always consult a doctor if you experience health problems during pregnancy to get drugs that are safe for pregnant women and fetuses.