• Dr Peter Chew

Intrauterine growth restriction (IUGR)

Sitting on the wheelchair with teary eyes and occasional sobs, she gazed patiently at her baby in the incubator at the neonatal intensive care unit (NICU). The baby weighing 1.2 Kg. looked no bigger than a kitten. It was thin and pale with loose, dry skin. It lay floppily with a number of tubes and wires attached to the monitoring machines. It cried feebly at times.


M, 34 just had a Caesarean section(C-section) 2 days ago .This was her first pregnancy . It was apparently normal until at 28 weeks of gestation when the levels of the fluid surrounding the baby (amniotic fluid) were found to be low. The growth of the baby had slowed as well. The estimated weight of the baby was at the 10th percentile with the measurement of abdomen 2 weeks behind that of the head. The baby was diagnosed as having intrauterine growth restriction (IUGR) a condition in which the baby was small for the gestation.


I asked M to come for frequent check-ups so that the baby’s growth can be monitored by ultrasound scans regularly. Her baby’s heart beats were also measured electronically by cardiotocograms (CTG) to ensure adequate oxygen supply. Steriod injections were also given to help improve the baby’s lung function. At the 33rd week of her pregnancy, CTG indicated that the oxygen supply to the baby was diminishing. The blood flow to the baby’s brain was reduced by Doppler flow studies. I discussed the gravity of the situation with M and her husband and decided that the baby should be delivered by C-section. The baby was born with a low Apgar score indicating its poor physical condition at birth. It was admitted to NICU in the incubator straight away for immediate medical care.


Intrauterine growth restriction (IUGR) is a condition where the unborn baby does not grow at the normal, expected rate. The estimated weight of the baby is less than that of 90% of those with the same gestational age. It occurs in about 2 to 3 percent of all pregnancies and results from diminished supply of the nutrients and oxygen to the baby.Although some IUGR babies are small because of genetic factors, majority are due to other causes which include:


Mother having :

Pregnant for the first time or for the fifth time or more

Under the age of 15 or over the age of 35

High blood pressure

Chronic kidney diseases

Diabetes

Heart or respiratory diseases

Anaemia

Infection from viruses ,bacteria or parasites

Alcohol, cigarette and drug abuse

Reduced blood flow to the womb and placenta:

Minor detachment of placenta before delivery

Low lying placenta with bleeding

Placental insufficiency


Unborn baby having

Infection

Birth defects

Genetic abnormality


When IUGR is severe, the foetal oxygen supply is critically compromised. This may cause foetal death. In less severe case, the baby may have problems after birth. These include:


Difficulty in breathing from inhalation of the first faeces(meconium) before or during delivery

Low blood sugar


Difficulty in maintaining the body temperature

Low resistance to infection

Increase in red blood cells resulting in abnormal clotting problems

Developmental and learning disorders during childhood


Management of IUGR depends on its onset and severity. Careful monitoring of the growth of the foetus using ultrasound and Doppler flow studies and optimal timing for delivery are important in achieving good outcome. It was quite an ordeal for M to watch her baby suffering in the incubator. Her face finally brightened up with smiles when it finally left the NICU after 2 weeks. When I saw her 6 weeks after the baby was born, it had put on a remarkable amount of weight and both mother and baby were doing well. “Doc, thanks for your timely intervention,” she said” thanks for letting me understand what motherhood really means.”I could see immense joy in her.



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