Chapter 213 Intrauterine Growth Restriction
INTRODUCTION
Description: Intrauterine growth restriction is symmetric or asymmetric reduction in the size and weight of the growing fetus in utero, compared with that expected for a fetus of comparable gestational age. This may occur for many reasons, but most occurrences represent signs of significant risk of fetal death or jeopardy to the fetus. Some authors advocate identifying fetuses with growth between the 10th and 20th percentiles as suffering “diminished” growth and at intermediate risk for complications.
Prevalence: Problems of consistent definition make estimates difficult; by most definitions 5% to 10% of pregnancies.
Predominant Age: Reproductive; higher at the extremes of childbearing. (For women younger than age 15 the rate of low birthweight is 13.6% compared with 7.3% for women between 25 and 29 years of age. When multiple gestations are excluded, the rate for women older than age 45 is greater than 20%.)
ETIOLOGY AND PATHOGENESIS
Causes: Idiopathic (50%). Maternal disease—hypertension; drug or alcohol use; smoking; Dilantin (phenytoin), coumarin, propranolol, or steroid use; poor nutrition, inflammatory bowel disease, low maternal weight (<50 kg), high altitude, hemoglobinopathy, cyanotic heart disease, multiple pregnancy, irradiation. Placental disease or abnormalities—placenta previa, fibrosis, chronic infection, partial abruption or infarction. Fetal factors—congenital anomalies, chromosomal factors, chronic fetal infections.
DIAGNOSTIC APPROACH
Workup and Evaluation
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