Intrauterine Growth Restriction

Question 1

List some aetiologies of intrauterine growth restriction

Answer 1

• Foetal
• Congenital - chromosomal (T21 and other trisomies), single-gene disorders, cardiac/other structural defects, infections (CMV, toxoplasmosis, malaria)
• Maternal
  
  • Hypertension, pre-pregnancy diabetes, obesity and maternal age, thrombophilia (especially acquired e.g. APL, SLE), toxins (cigarettes, THC, EtOH, cocaine, warfarin, anticonvulsants), malnutrition, anaemia, cardiorespiratory disease
• Placental
  
  • Multiple pregnancy, placental abruption, placental insufficiency (e.g. poor implantation)

Question 2

What is the difference between asymmetrical and symmetrical IUGR?

Answer 2

• Symmetrical - all growth parameters affected, tends to result from early pregnancy exposure or problems. No head sparing so long-term prognosis not as good
• Asymmetrical - weight and length decreased but head normal size. Results from later pregnancy problems (e.g. acute compromise). Usually rapid growth and better prognosis

Question 3

What are some of the complications that can result from intrauterine growth restriction?

Answer 3

• Increased preterm labour, perinatal mortality, neonatal morbidity
• Increased risk of childhood motor or intellectual handicap
• Increased risk of long-term adult health outcomes (hypertension, diabetes, hyperlipidaemia) - Barker hypothesis (developmental origins of adult disease)

Question 4

How is IUGR prevention managed?

Answer 4

• Aspirin (selected subsets e.g. pre-eclamptic)
• Work and rest optimisation