2023-12-17 21:54:01
Definition: when do we talk about IUGR?
And intrauterine growth retardation or RCIU means that the fetus is small for its gestational age because of a slowdown in growthduring gestation.
IUGR is defined as a birth weight below the 10th percentile. But we must distinguish the case of a fetus small for its gestational age (or SGA) from IUGR. Indeed, IUGR is associated with arguments in favor of a pathological growth defect. Dr. Omrane Ben Rejeb, gynecologist.
IUGR is observed during ultrasound : the measurements (including those of the head circumference), the weight and the height are lower than the normal values corresponding to the gestational age.
The leading cause of miscarriage
This obstetric pathology is common: the incidence of IUGR is one in ten pregnancies in developed countries (source 1). It may have no consequences on the baby’s health. However, it remains the primary cause of in utero mortalitythis is why it should be detected in time in order to impose medical surveillance (in case it is detected).
- And Moderate IUGR corresponds to measurements below the 10th percentile.
- And Severe IUGR corresponds to measurements below the 5th percentile. These fetuses are most at risk of suffering a medical problem. They must be closely monitored during pregnancy.
Inserm and health authorities deplore that IUGR is still underdiagnosed in France. According to some studies, only 21% of children born with low birth weight were suspected of IUGR during pregnancy (source 2).
Harmonious or disharmonious IUGR: what is the difference?
On distingue 2 types of intrauterine growth restriction (IUGR) :
What causes intrauterine growth restriction (IUGR)?
There are several situations that can explain IUGR:
- And low birth weight of one or both parents. In this case, there is no need to worry: the IUGR is said to be “constitutional”. It does not cause health problems for the fetus.
- A genetic or chromosomal abnormality like dwarfism for example. It is then necessary to eliminate the diagnoses causing a disability.
- A infection contracted by the mother as a cytomegalovirus, the rubellathe toxoplasmosischickenpox, syphilis or even herpes.
- The taking toxins during pregnancy : alcohol, tobaccoor others drugs.
- And uterine notch which corresponds to a drop in blood flow in one or both arteries which irrigate the uterus during pregnancy. It is detected after the 5th month using a uterine Doppler.
- A placental insufficiency characterized by insufficient blood flow to the placenta during pregnancy, resulting in a reduced supply of oxygen and nutrients to the fetus. This anomaly explains 5% of IUGRs. It can lead to fetal distress or fetal death.
In almost a third of cases, IUGR has no identified cause (we are talking about Idiopathic IUGR).
What are the risk factors for intrauterine growth restriction (IUGR)?
IUGR can affect any woman during pregnancy regardless of age, ethnicity, health history and lifestyle. However, certain factors increase the risk of IUGR:
- And history of IUGR during a previous pregnancy;
- L’maternal age over 35 ;
- The primiparity (the first pregnancy) and grand multiparity (a history of several pregnancies);
- A twin pregnancy or multiple;
- Hypertensive disorders: chronic high blood pressure, preeclampsiapregnancy-induced hypertension;
- Anddiabetes pre-existing pregnancy with vascular damage;
- The smoking active during pregnancy;
- The alcohol consumption during pregnancy ;
- The drug use during pregnancy ;
- The malnutrition or one diet unbalanced;
- L’underweight (weight loss or even malnutrition);
- L’obesity.
IUGR: what are the consequences on the child’s health?
We must distinguish between short-term and long-term consequences.
Risks of complications before birth or at birth
- The death of the fetus (miscarriage);
- death during childbirth;
- A cerebral palsy leading to a handicap at birth.
The risk is prenatal but also postnatal morbidity and mortality. IUGR is also a risk factor for atypical child development. Dr. Omrane Ben Rejeb, gynecologist.
Long-term consequences in children and even adults
- And neurodevelopmental slowing ;
- Of the minor cognitive deficits ;
- Of the symptoms of hyperactivity and inattention ;
- Of the academic difficulties ;
- In adults: a increased risk of cardiovascular diseasehigh blood pressure, carbohydrate intolerance, diabetes, dyslipidemia and obesity.
Most affected infants regain their weight before 6 months and their height before 1 year (source 3).
Diagnosis of IUGR: how to know?
The diagnosis is guided by the observation of a decreased fundal height compared to the gestational age during the clinical examination. It is confirmed by ultrasound which shows fetal growth below the 10th percentile. Dr. Omrane Ben Rejeb, gynecologist.
Depending on the severity of the IUGR and the stage of the pregnancy at the time of diagnosis, additional tests may be prescribed such as:
- A ultrasound detailed allowing the diagnosis of congenital malformation;
- A genetic amniocentesis ;
- Of the samples to look for infections ;
- Other tests to look for maternal illnesses that could explain IUGR such as high blood pressure or diabetes with vascular damage.
IUGR: how to treat it? What to do ?
Management of IUGR varies depending on its cause, severity and stage of pregnancy. However, treatment resources are limited. “Treatment is done on a case-by-case basis. Usually, care is multidisciplinary: gynecologist, geneticist, pediatrician (after birth), diabetologist…”, underlines the expert.
In the event of a genetic anomaly or infectious cause, the risks of disability, malformation or mental retardation are significant. It is therefore possible to request a medical termination of pregnancy (IMG) regardless of the stage of pregnancy. The IMG is carried out in a health establishment or hospital. It is practiced by medication, surgery or by inducing childbirth through natural means.
In the event of placental insufficiency or uterine notch: monitoring of the fetal heart rate can be implemented from the 6th month of pregnancy to detect signs of suffering. These manifestations can lead to premature delivery.
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