Updated: Feb 6, 2020
What is Intrauterine Growth Restriction (IUGR)?
Intrauterine Growth Restriction (IUGR) is when the baby in the womb is smaller than it should be for it’s gestational age, indicating it is not growing at the normal rate. The reasons for why this occurs can be varied and sometimes unknown.
Delayed growth can put the baby at risk of health problems during pregnancy, delivery and once they are born. If IUGR occurs in a first pregnancy, there is a higher chance of it occurring in subsequent pregnancies, however it can just occur in one pregnancy without affecting any further pregnancies.
At the end of this blog I share my own experiences of IUGR.
Reasons for IUGR
There can be factors in the baby which increase the risk of growth restrictions, such as:
· Genetic or chromosomal defects
· Heart defects
· Multiple birth (being a twin or triplet etc)
Issues with the placenta and umbilical cord are commonly the cause of growth restrictions in an unborn baby. If the placenta is poorly positioned or not securely attachment within the womb this can affect the nutrients received by the baby from the mother. If the blood flow, from the placenta to the baby, via the umbilical cord, is compromised in any way, this can slow the baby’s growth.
Alternatively, if the mother has any of the following pre-existing medical conditions, this could cause slowed growth, for example:
· High blood pressure
· Chronic anaemia
· Lung disease
· Heart disease
· Kidney disease
· Very low weight before and/or during pregnancy
· Poor nutrition or weight gain during the pregnancy
· Alcohol and/or drug use
Sometimes there are no apparent reasons for why the growth is slow. Equally there will be some babies who are just small at birth and they present with no problems.
Symptoms of IUGR
For the mother it is almost impossible to know if you have IUGR until it has been professionally diagnosed as there are no symptoms. Once the baby is born, it can show some signs and symptoms of IUGR, such as:
· Low birth weight
· Low body fat
· Low blood sugar level (Hypoglycemia)
· Low body temperature (Hypothermia)
· Low oxygen levels (Perinatal Asphyxia)
· Difficulty fighting infection
· High number of red blood cells (Polycythemia) – this can thicken the blood and mean they need IV fluids to thin the blood so it can flow better
· Feeding problems
Diagnosis of IUGR
The best way of seeing growth restrictions is through ultrasound scans. During these scans your healthcare provider will be able to accurately measure the size of your baby, including circumference of the head and waist, as well as the length of arms and legs and the size of their heart.
To be given the diagnosis of IUGR, the size of the baby in the womb is usually at or below the 10th percentile, which means it is measuring smaller than 9 out of 10 babies at the same gestational age.
Doppler tests are also important for helping to understand the underlying reason for the IUGR. A doppler test monitors the blood flow from the placenta to the baby, through the umbilical cord. This test can used during diagnosis as well as for ongoing monitoring once IUGR has been diagnosed. It is important to check that the blood flow from the placenta to the baby is not compromised at any time.
Ongoing Management of IUGR
Once IUGR has been diagnosed, you will receive regular check ups, scans and tests to closely monitor the progress of the baby. Depending on the severity, these appointments could be every 1-2 weeks, especially in the later weeks of pregnancy, or if the growth continues to slow.
You will also be asked to carefully monitor fetal movements and flag any unusually quiet periods. The pattern and frequency of your baby’s movements are a good indication of how they are doing in the womb. If you suddenly notice less movements and activity from your baby, contact your healthcare provider as soon as possible to have it checked.
The baby’s growth will be carefully recorded at each check up and plotted onto a graph so that the pattern of growth can be assessed. If the growth continues to slow they may consider an early delivery.
More often now, IUGR babies are delivered via a planned C-section. The process of vaginal delivery can cause unnecessary stress for a small baby and can result in their heartrate dropping during birth, thus leading to an emergency c-section. It is far better for the health of the mother and baby to have a planned c-section in this scenario so that the baby can be closely monitored in a controlled and calm environment.
My Experience with IUGR
During my first pregnancy I was diagnosed with IUGR at around 30 weeks. At this time growth had slowed down from about 24 weeks. IUGR can be diagnosed at any time during pregnancy, hence why it is so important to attend all your appointments and check ups.
The scans didn’t reveal any obvious reasons as to why growth had slowed so much, however the baby’s growth had dropped to below the 5th percentile. As such we were regularly monitored every 1-2 weeks from this point until birth at around 38.5 weeks. I had a planned c-section and my baby boy was delivered weighing 6lb exactly.
After birth he did show some signs of IUGR. Firstly his weight was low and then dropped to 5.5lb later that week. He did have trouble feeding and we battled with a low a low blood sugar level for him for the first few days. We stayed in hospital for 5 days until he was starting to feed a bit better and his blood sugar level was maintained.
Thankfully our baby didn’t require any special care after birth, but we had been advised to go to a hospital specialising in neonatal care should there be any problems. This certainly gave us confidence for the delivery as we knew we had a great team of experts around us.
Best wishes for your pregnancy and birth,
The Bamboo Baby Company xx