What is iugr in babies?

Intrauterine growth restriction is based on having an accurate gestational age or determining your due date. This is found by identifying the first day of your last menstrual period and by performing a first-trimester ultrasound. Having this date gives your healthcare provider a baseline for diagnosing IUGR.

Once your provider determines gestational age (or weeks in pregnancy), they can can diagnose IUGR using a few different methods.

Fundal height is the size of your belly from the top of your pubic bone to the top of your uterus or the size of your "baby bump." Your healthcare provider measures your fundal height using measuring tape (usually made of paper). They place one end on your pubic bone and the other end at the top of your uterus.

Fundal height is measured in centimeters (cm) and should be about the same number you are in weeks of pregnancy (after 20 weeks). For example, if you are 32 weeks pregnant, your fundal height should be around 32 cm. Your healthcare provider may suspect IUGR if you measure at least 4 cm less than what your fundal height should be. So, in this example, your provider may suspect IUGR if your fundal height is 28 cm or lower.

Your provider can also use their hands to feel certain areas of your belly (called palpation) and estimate the size of the fetus.

Your healthcare provider measures your weight at every prenatal appointment. Poor weight gain could indicate that the fetus is also not gaining enough weight.

If you are diagnosed with IUGR, you will have additional ultrasounds to monitor fetal growth throughout your pregnancy.

During a fetal ultrasound, your healthcare provider moves a wand or probe across your belly. Sound waves from the ultrasound create a picture of the fetus. Your healthcare provider uses the picture to take measurements and estimate the size and weight of the fetus. They can also use ultrasound to check the blood flow from the placenta through the umbilical cord or through the blood vessels (this is called Doppler flow). Poor circulation of blood can suggest IUGR.

Ultrasound can also measure the amount of amniotic fluid surrounding the fetus. Too little amniotic fluid could indicate IUGR.

Intrauterine growth restriction is based on having an accurate gestational age or determining your due date. This is found by identifying the first day of your last menstrual period and by performing a first-trimester ultrasound. Having this date gives your healthcare provider a baseline for diagnosing IUGR.

Once your provider determines gestational age (or weeks in pregnancy), they can can diagnose IUGR using a few different methods.

Fundal height is the size of your belly from the top of your pubic bone to the top of your uterus or the size of your "baby bump." Your healthcare provider measures your fundal height using measuring tape (usually made of paper). They place one end on your pubic bone and the other end at the top of your uterus.

Fundal height is measured in centimeters (cm) and should be about the same number you are in weeks of pregnancy (after 20 weeks). For example, if you are 32 weeks pregnant, your fundal height should be around 32 cm. Your healthcare provider may suspect IUGR if you measure at least 4 cm less than what your fundal height should be. So, in this example, your provider may suspect IUGR if your fundal height is 28 cm or lower.

Your provider can also use their hands to feel certain areas of your belly (called palpation) and estimate the size of the fetus.

Your healthcare provider measures your weight at every prenatal appointment. Poor weight gain could indicate that the fetus is also not gaining enough weight.

If you are diagnosed with IUGR, you will have additional ultrasounds to monitor fetal growth throughout your pregnancy.

During a fetal ultrasound, your healthcare provider moves a wand or probe across your belly. Sound waves from the ultrasound create a picture of the fetus. Your healthcare provider uses the picture to take measurements and estimate the size and weight of the fetus. They can also use ultrasound to check the blood flow from the placenta through the umbilical cord or through the blood vessels (this is called Doppler flow). Poor circulation of blood can suggest IUGR.

Ultrasound can also measure the amount of amniotic fluid surrounding the fetus. Too little amniotic fluid could indicate IUGR.

Intrauterine growth restriction (IUGR) (also referred to as fetal growth restriction, or FGR) describes a condition in which the unborn baby is smaller than expected for his or her gestational age, or the number of weeks that the baby has been in the uterus. The term for a newborn baby who is smaller than expected is small for gestational age (SGA).

Unborn babies with IUGR typically have an estimated weight that is less than the 10th percentile. That means their weight falls below that of 90 percent of unborn babies of the same gestational age. They may be proportionally small (all parts of the baby are smaller than expected) or asymmetrically small (one part of the baby is smaller than expected). IUGR babies are sometimes born prematurely (before 37 weeks of pregnancy).

Babies with IUGR are at greater-than-normal risk for a variety of health problems before, during and after their birth. These problems include low oxygen levels while in the womb, a high level of distress during labor and delivery, and an increased risk of infectious disease after birth. IUGR also raises the risk of long-term growth problems and metabolic disease (a group of health problems that put children at risk of chronic diseases, such as type 2 diabetes and heart disease).

Not all babies whose weight is in the 10th percentile have complications or concerns related to IUGR, however. Many healthy babies are born small due to their parents being smaller than average in stature.

At Midwest Fetal Care Center, a collaboration between Children’s Minnesota and Allina Health, we specialize in individual attention that starts with you having your own personal care coordinator to help you navigate the complex process of caring for your babies. We use a comprehensive team approach to IUGR. That way, you are assured of getting the best possible information by some of the most experienced physicians in the country. For IUGR, your care team may include a maternal-fetal specialist, a pediatric cardiologist, a neonatologist, a nurse specialist care coordinator, a fetal care clinical social worker and several other technical specialists. This entire team will follow you and your baby closely through the evaluation process, and the team will be responsible for designing and carrying out your complete care plan.

Meet the team

The restricted growth associated with IUGR is caused by the baby not receiving enough nutrients and oxygen in the uterus to grow at a normal rate. Many factors can lead to an insufficient flow of nutrients and oxygen. As shown in the lists below, possible factors fall into three main categories: some are related to the mother, others to the baby and still others to abnormalities in the placenta and/or uterus.

IUGR may develop at any time during pregnancy. The key tool used to diagnosis the condition is ultrasound. Ultrasound enables your doctor to accurately measure the size of your baby’s head, abdomen, arms and legs. Those measurements are then used to calculate the baby’s estimated weight, which is compared with a growth chart of the average weight of babies at a similar gestational age.

Starting at around 20 weeks, your doctor will estimate the size of your baby at each prenatal visit. Your doctor will do this by measuring the distance from the mother’s pubic bone to the height of the top of the uterus (the fundus). If the measurement is not as expected for the number of weeks of the pregnancy, or if the mother has had difficulty gaining weight, an ultrasound will be ordered to determine if your baby has IUGR.

If you are at high risk of having a baby with IUGR, your doctor will follow your baby’s growth during the pregnancy with early and more-frequent-than-usual ultrasound exams.

Once IUGR is diagnosed, other tests may be conducted to try to determine the cause of the condition. If it’s thought that the cause may be a maternal infection, for example, a sample of the mother’s blood may be taken and tested for signs of a recent infection. In some cases, an amniocentesis test, which can be used to evaluate amniotic fluid for signs of infection, may be recommended.

To determine if the IUGR is related to a genetic abnormality, the ultrasound images of your baby’s anatomy will be carefully examined for signs of birth defects. You may be referred to a genetic counselor, who will discuss options for genetic testing.

Ultrasound images are also used to determine if there is too little amniotic fluid around the baby (a condition known as oligohydramnios) or if there is an abnormal flow of blood from the umbilical cord into the placenta. Both are associated with the development of IUGR. A special type of ultrasound known as Doppler flow, which measures the speed and amount of blood as it moves through a blood vessel, may be used to assess how the baby is responding internally to the growth restriction.

The rate of your baby’s growth (how much the baby grows between your prenatal visits) will be closely followed. This monitoring often helps to distinguish between a baby who is smaller-than-average but healthy and one who has IUGR. For example, if the baby’s growth continues to increase between prenatal visits, if the amount of amniotic fluid is normal, and if blood flow into the placenta is normal, then the baby is less likely to have the condition.

Our prenatal management of babies with IUGR centers on monitoring the baby frequently with high-resolution ultrasonography. To gather additional information, other technologies may be used, including fetal echocardiography and amniocentesis.

High-resolution fetal ultrasonography is a non-invasive test performed by one of our ultrasound specialists. The test uses reflected sound waves to create images of your baby within the womb. We will use ultrasonography to follow the development of your baby’s internal organs and overall growth throughout the pregnancy. The test will also allow us to keep track of the amount of amniotic fluid surrounding your baby, as well as how well blood is flowing through the umbilical cord, as well as within your baby’s other blood vessels.

Fetal echocardiography (“echo” for short) is performed at our center by a pediatric cardiologist (a physician who specializes in fetal heart abnormalities). This non-invasive, high-resolution ultrasound procedure looks specifically at how your baby’s heart is structured and how well it is functioning within the womb.

An amniocentesis is done to sample the amniotic fluid around your baby. This fluid will contain some of your baby’s cells, which will provide a full set of your baby’s chromosomes for us to analyze. Amniotic fluid can also be assessed for infection if there is suspicion that an infection could be contributing to IUGR. The amniocentesis procedure is straightforward and can be done in our clinic. It requires placing a small needle through the mother’s abdomen and into the amniotic sac to obtain the fluid sample. Getting final results from the test from our laboratory usually takes several days. The information will be very important for creating your care plan and helping the neonatologist care for your infant after birth.

The prenatal management of IUGR depends on a variety of factors, including the severity of the baby’s growth restriction, the timing of when during the pregnancy the IUGR began, the mother’s health, and the presence of any birth defects or genetic anomalies. Babies with IUGR are at increased risk of stillbirth. To reduce this risk, your baby will be closely monitored.

In addition to frequent ultrasound exams, one or more of the following techniques may be used by your doctor to monitor your pregnancy and watch for potential problems:

Fetal-kick counting. Your doctor may ask you to keep track of your baby’s kicks and movements. If your baby’s movements change significantly, it might be a sign that the baby is under stress.

Non-stress test. For this test, a special monitor is placed on the mother’s abdomen to listen to the baby’s heart-rate pattern. Certain changes in the baby’s heart rate can be a sign that the baby is under stress.

Biophysical profile. This test is a combination of the non-stress test and an ultrasound. A heart-rate monitor is placed on the mother’s abdomen during an ultrasound exam, allowing your doctor to observe the baby’s heart rate while the baby is moving within the womb. Your doctor will use the test, which can last for up to 30 minutes, to determine if your baby is receiving enough oxygen from the placenta. The test also helps to assess the amount of amniotic fluid surrounding the baby.

Doppler flow studies. Doppler flow is a particular type of ultrasound. It uses sound waves to measure the amount and speed of blood as it moves through a blood vessel. Your doctor will use Doppler flow to observe how well blood is flowing to the umbilical cord. The test will also enable your doctor to assess blood flow in your baby’s brain, heart and other organs.

Sometimes a mother can take steps to improve the growth of her unborn baby, such as by stopping smoking or by eating more nutritious foods. In most cases, however, the mother is unable to affect the growth of the baby. Prenatal treatment for IUGR focuses, therefore, on close monitoring of the pregnancy. The goal is to continue the pregnancy for as long as safely possible.

In some cases, hospitalization of the mother is recommended. This enables the unborn baby to be very closely monitored. If IUGR endangers the health of the baby, an early delivery may be necessary. Babies with IUGR are often delivered by cesarean section, as their weakened condition can make it difficult for them to tolerate the stress of labor and delivery.

Many babies with IUGR are born prematurely, but our goal will be to have your baby delivered as close to your due date as possible. If early delivery is a concern, we will recommend that your baby be born at a hospital able to care for premature babies, such as The Mother Baby Center at Abbott Northwestern and Children’s Minnesota in Minneapolis or The Mother Baby Center at United and Children’s Minnesota in St. Paul. Children’s Minnesota is one of only a few centers nationwide with a birth center located within the hospital complex. This means that your baby will be born just a few feet down the hall from our newborn intensive care unit (NICU). Also, many of the physicians you have already met will be present during or immediately after your baby’s birth to help care for your baby right away.

The long-term prognosis for babies with IUGR depends on the severity of the condition, the reason for the IUGR (such as a birth defect), and the age of the baby at delivery. The longer the baby stays in the womb before birth, the less likely he or she will experience complications.

Some of the health problems babies with IUGR may experience after birth are low blood sugar, difficulty maintaining normal body temperature, difficulty eating and neurodevelopmental delays.

Because of the potential health issues associated with IUGR, your baby may require long-term follow-up care. At Children’s Minnesota, we have developed a detailed care plan for babies who experienced IUGR during pregnancy. Your baby’s plan will be implemented by a comprehensive team of specialists, including a pediatrician (who will coordinate your baby’s overall care), a pediatric cardiologist, a developmental specialist and any other caregiver your baby may require.

Intrauterine growth restriction (IUGR) is a condition in which the baby does not grow properly during its time in the mother’s womb. It is due to a mix of factors including disease conditions in the mother, genetic defects in the baby, and poor placental growth.

These babies may do worse than normal babies during the stress of labor, and if severely restricted in growth, may even die in the womb. For this reason, IUGR is a condition which should be properly diagnosed and treated.

The management of IUGR depends on the cause, if any is identified, and the stage of pregnancy at which the baby stops growing normally.  This is because the greatest damage occurs when IUGR is seen from early pregnancy onwards, and such babies must be carefully monitored until their birth to make sure they don’t die in the womb. Following their delivery, many more tests may be needed to determine the type of follow-up care they need.

Before delivery, the caregiver needs to keep a careful eye on the baby. This is done by a set of tests:

Once IUGR is diagnosed, various treatments such as bed rest, increased or supplemental food intake to increase the baby’s weight, and treatment of any medical condition, may be recommended. Bed rest may improve circulation to the baby in some cases, though evidence is weak. Again, in women who are severely malnourished, better food may make some difference in the growth of the baby, but it is unlikely to benefit the baby who is not obtaining food because of a poorly functioning placenta.

The mother of an IUGR baby should stop habits such as smoking, drinking and taking drugs. Good food, rest and regular prenatal care may help to some extent to control some factors contributing to IUGR. Of course, this will also help to ensure the baby is born in a good environment where people are prepared to take care of a high-risk newborn.

During the birth process, it is important to choose the type of delivery so that the baby does not suffer from birth asphyxia, or lack of oxygen during birth. If it is present it should be treated promptly but carefully.

If all the antenatal tests show that the baby is doing reasonably well and is still growing, the pregnancy is allowed to continue until term. Some centers provide a course of glucocorticoid injections in the period between 24 and 34 weeks so that the baby’s lungs can mature, if delivery becomes absolutely necessary before term. If the tests become abnormal, and especially if fetal growth stops altogether, delivery often becomes the only way out even if the baby is very preterm. Such a decision is taken after explaining all the risks associated with delivering a preterm baby and the risks of having a stillborn or severely asphyxiated (suffocated) baby if the pregnancy is allowed to continue.

A test involving the use of oxytocin, a drug which induces contractions of the uterus, is often carried out to see if the baby can tolerate this type of stress. However, many centers prefer a combined NST with a BPP if required.

Considering the risk of birth asphyxia and other problems linked to a small and often preterm baby, the delivery should take place only in a center equipped to handle such babies and to offer emergency C-sections if required.

The complete physical examination of the baby is important to try and identify the type of IUGR that the baby suffers from. This will record the birth weight, the head circumference, the mid-arm circumference, the abdominal circumference and the length. A baby who is small all over probably has a genetic defect or has acquired an infection in the womb, which has destroyed many of the baby’s cells. Such causes may also be identified by the presence of abnormal body features and physical defects. On the other hand, babies with a relatively large head and a widened body are probably suffering from lack of food more than anything else.

In addition, the baby should be tested for hypoglycemia (low blood sugar), because this leads to many other complications including breathing problems, infections, low body temperature and drop in blood calcium levels. Other tests which are usually done at this time include blood counts to detect infections and unduly high red cell count (polycythemia).

These babies should be given intravenous fluids carefully calculated to cover their needs, including the water lost by fast breathing to get more oxygen. They should be given a higher caloric intake as they grow to help them achieve catch-up growth, something like 100 kilocalories or more per kg per day. Regular assessments will help determine what areas of mental and physical development require special help.

IUGR babies often die at or soon after birth, with a death rate 5-20 times higher than normally grown infants. Much of this is due to death in the womb, suffocation during birth, and the presence of birth defects.

Many infants who were growth-restricted never do catch up, perhaps one in every three. This is probably due to the double stress of nutritional deprivation in the womb coupled with preterm birth. The toll is higher as the period in which the baby could grow in the womb becomes shorter, and also with lower birth weights.

Neurologic damage occurs 5-10 times more often in these babies, with obvious learning deficits, short attention spans, and visual-motor coordination difficulties. It is especially high in those babies whose heads are relatively small at birth. Genetic defects and infections occurring before birth are uniformly associated with neurologic abnormalities. In other cases, a good birth experience and a correctable cause of growth restriction usually gives a better outcome, if the baby is kept warm, fed correctly and monitored properly.

Long-term, these babies seem to develop an abnormal cell programming of the endocrine system and other body metabolic regulators during their time of deprivation in the womb. This predisposes them to adult diseases such as hypertension, coronary disease and hypercholesterolemia, and diabetes mellitus.

IUGR stands for intrauterine growth retardation. This means that your baby is growing slowly and doesn't weigh as much as your doctor expected for this stage of pregnancy. If your unborn baby weighs less than most babies at this stage, your baby might have IUGR.