It is called intrauterine growth retardation (IUGR, IUGG) if
the fetus is below a certain ratio (10%) from the determined standard weight
that should be according to the gestational week. It is important to note that
there is no growth retardation in every fetus smaller than the standard weight
that should be considered, the majority of which are structurally small
fetuses.
In fetuses with intrauterine growth retardation (RIG), the
risk of stress, exposure to asphyxia, and death in the newborn period are
higher than normal pregnancies.
IUGR is divided into two types: type 1 (symmetrical) and type
2 (asymmetrical). Type 1, that is, symmetrical growth retardation is 20-30% of
all babies with developmental retardation. This is caused by problems in the
early months of pregnancy. The body of the fetus is proportionally head,
abdomen, leg are all small. Chromosomal or structural diseases, toxic
substances faced by the pregnant woman in early pregnancy period, or viral
infections passed can cause this type of developmental delay.
Type 2 developmental delay constitutes 70-80% of IUGRs. In
type 2 asymmetric growth retardation, the event is not symmetrical and there
are different sizes between organs. Generally, when the baby's head and leg
development was normal, the abdomen remained behind what should be. Asymmetric
growth retardation is caused by diseases such as high blood pressure and
diabetes, which usually occur in the last months of pregnancy.
In order to distinguish between symmetrical and asymmetrical
growth retardation, the ratio of head circumference and leg circumference
measured on ultrasonography to abdominal circumference is calculated and if
this ratio is high, it is interpreted in favor of asymmetric IUGR.
Causes of
growth retardation:
- Vascular diseases, hypertension, diabetes, heart diseases
in the mother
- Preeclampsia
- Kidney, liver diseases, other chronic diseases in the
mother
- Mother's asthma
- Sickle cell anemia in mother
- Nutritional deficiency in the mother
- Placenta abnormalities (Circumvallat placenta)
- Mother's smoking, alcohol, drug use
- Malnutrition of the mother
- Anemia in the mother
- Congenital anomalies of the fetus
- Chromosome anomalies
- Twin and other multiple pregnancies
- Fetus-related infections (CMV is the most common
IUGR-causing infection)
- Antiphospholipid antibody syndrome
Diagnosis:
Ultrasound and doppler ultrasound are diagnostic methods in
the diagnosis of IUGG. Oligohydramnios (low amniotic fluid) are more common in
these. Amnion fluid measurement below 50 is a bad criterion. On ultrasound, the
baby's head circumference, leg length, abdomen circumference, and estimated
weight are measured and compared to normal standards according to the
gestational week.
Treatment approach:
Pregnancies diagnosed with IUGG are more closely followed,
and during this follow-up, delivery is performed if the fetus is found to be at
very high risk in the womb, according to the followings of ultrasound, doppler
and NST, biophysical profile (BPP). Although these babies can be born in the
normal way, they are more likely to require cesarean than normal pregnancies.
It is considered that the risk is high in pregnancies with
amnion fluid less than 50 and with high doppler measurements, no growth in the
baby during weekly ultrasound follow-ups, NST non-reactive, scoring 6 or less
in biophysical profile evaluation, and delivery is planned as soon as possible.
Betamethasone (steroid) drug is given to ensure the lung development of the
fetus, since premature birth may be required.
ADDITIONAL
INFORMATION:
- In trisomy 18, IUGR is very typical, in the first months of
pregnancy, lag in the CRL measurement begins early enough to be monitored. IUGR
is common in trisomy 13, but it is rare in trisomy 21. IUGR can also be seen in
Turner syndrome.
- Some of the infections most associated with IUGR: CVM (most
common), rubella (rubella), toxoplasma, varicella, malaria, syphilis,
tuberculosis, listeria ...
- There are studies reporting that IUGR and polhidramnios are
more common in infants of high altitude.
-PLASENTA CALIFICATION
-PLACENTAL ABRUPTION
-PLASENTA PREVIA
-UTERIN INCARSERATION
