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Chapter-27 Intrauterine Growth Restriction

BOOK TITLE: Essentials of Obstetrics

Author
1. Pai Muralidhar V
ISBN
9788180613623
DOI
10.5005/jp/books/10288_27
Edition
1/e
Publishing Year
2004
Pages
7
Author Affiliations
1. Kasturba Medical College, Manipal, India, Kasturba Medical College, Manipal, India, e-mail: mvpai@mahe.manipal.edu, Kasturba Medical College, Manipal, Kasturba Medical College and Hospital, Manipal, Karnataka, India, Kasturba Medical College, Manipal, Karnataka, India, Kasturba Medical College, Manipal University, Manipal, Karnataka, India, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
Chapter keywords
Intrauterine Growth Restriction (IUGR), growth velocity, fetus, symmetrically small infants, chromosomal, asymmetrically small babies, gestational age, uteroplacental insufficiency, maternal-fetal circulation, hemodynamic changes, uterine and fetal circulations, cytotrophoblast cells, decidua, myometrium, newborn infants, head, chest, abdominal circumference, subcutaneous tissue, muscle mass, fetal growth, menstrual age, antenatal testing, obstetrician, oligohydramnios, abnormal Doppler parameters, uterus, cesarean section, abnormal cardiotocography, low rupture of membranes, oxytocin

Abstract

Intrauterine Growth Restriction (IUGR) is the term applied to an infant whose growth velocity as a fetus was less than expected. Traditionally two types of IUGR have been described symmetrical and asymmetrical. Symmetrically small infants are perfect miniatures, in that they are correctly proportional but are small. Some will be small because of chromosomal, infective or environmental factors that exert an influence early in pregnancy. Asymmetrically small babies are long and thin at birth. They have a head size that is appropriate for gestational age but have wasted bodies. They look as though they have been starved. This is true because in most cases their size is the result of “uteroplacental insufficiency”. The functional anatomy of the maternal-fetal circulation is characterized by profound hemodynamic changes in the uterine and fetal circulations in early pregnancy. The cytotrophoblast cells migrate through the decidua and into the myometrium. It is clear from the studies of newborn infants that IUGR can manifest as a decrease in weight, length, head, chest, abdominal circumference, subcutaneous tissue and muscle mass, singly or in various combinations. The assessment of fetal growth requires an accurate knowledge of the menstrual age of the fetus. The role of antenatal testing has been traditionally considered to aid the obstetrician in managing the pregnancy to enable an optimal outcome, if possible, for both mother and baby. The crucial decision in the management of IUGR is the timing of the delivery. In the presence of severe oligohydramnios and abnormal Doppler parameters, delivery may be contemplated earlier than term. The baby might do well outside than inside the uterus. Cesarean section may be considered for severe IUGR with or with out abnormal cardiotocography and fetal distress. If cardiotocography is normal, labor may be induced with low rupture of membranes followed by oxytocin.

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