Intrauterine restriction (IUGR)

Abstract

Perinatal mortality and morbidity is markedly increased in intrauterine growth restricted (IUGR) fetuses. Prenatal identification of IUGR is the first step in clinical management. For that purpose a uniform definition and criteria are required. The etiology of IUGR is multifactorial and whenever possible it should be assessed. When the cause is of placental origin, it is possible to identify the affected fetuses. The major complication is chronic fetal hypoxemia. By monitoring the changes of fetal vital functions it is thus possible to improve both management and outcome. The timing of delivery is crucial but the optimal management scheme has not yet been identified. When IUGR is identified at very early gestational ages, serial assessments of the risk of continuing the in utero fetal life under adverse conditions versus the risks of the prematurity should be performed. Delivery of IUGR fetuses should take place in centers where appropriate neonatal *This paper was produced under the auspices of the WAPM for a consensus on issues in perinatal practice, coordinated by Giampaolo Mandruzzato, MD. **Corresponding author: Giampaolo Mandruzzato, MD Via del Lazzaretto vecchio 9 34132 Trieste Italy E-mail: mandruzzatogiampaolo@tin.it assistance can be provided. Careful monitoring of the IUGR fetus during labor is crucial as the IUGR fetus can quickly decompensate once uterine contractions have started.

Oxidative stress in pregnancy and fertility pathologies

“…The ideal diagnosis seems to be divided in a two-stage process: restriction of the growth by ultrasonography and use of transcerebellar diameter when gestational age is questionable (Mandruzzato et al 2008). Despite being a multifactorial etiology pathology (Mandruzzato et al 2008), most cases with no genetic or infectious cause are thought to be related to a compromised maternal blood circulation to the placenta, based on high-resistance uterine arterial waveforms and morphological studies of the spiral arteries (Burton and Jauniaux 2011), associated with deregulation of villous vasculogenesis and abundant fibrin deposition (Scifres and Nelson 2009). IUGR is associated with increased risk of fetal mortality and morbidity (Garite et al 2004) and predisposes children to an increased risk of hypertension, cardiovascular disorders, and renal diseases in adult-hood (Scifres and Nelson 2009).…”

Ultrasound and Biochemical First Trimester Markers as Predictive Factors for Intrauterine Growth Restriction

“…Intrauterine Growth Restriction (IUGR) is defined as the pathologic inhibition of intrauterine fetal growth and the failure of the fetus to achieve its growth potential [1]. It occurs in about 10% of pregnancies [2] and considered by the American College of Obstetricians and Gynecologists "the most common and complex problem in modern obstetrics" [3].…”

Enteral feeding of intrauterine growth restriction preterm infants: theoretical risks and practical implications

“…In developed countries, 3-7% of newborns are classified as IUGR. 2 The most common cause of IUGR is the placental obliterative vasculopathy that reduces nutrients and oxygen supply to the fetus; the causes include, but are not limited to, maternal malnutrition, maternal hypertension and idiopathic placental insufficiency. Placental insufficiency may be characterized by blood flow redistribution to the vital organs (brain, myocardium, and adrenal glands), while other organs, including the gastrointestinal tract, are deprived from sufficient blood flow.…”