Intrauterine Growth Restriction or IUGR is a term typically used to describe those babies who fail to achieve normal growth during pregnancy. A common threshold for the assessment of Intrauterine Growth Restriction, is a baby whose estimated weight is less than the 10th percentile of what otherwise would normally be expected.
Fetal growth and development is typically assessed by measurements of the uterine fundal height or through ultrasonography.
It is generally felt that, up to approximately 30 weeks of gestation, uterine fundal height measurements should closely correspond with gestational age. In other words, if, for example, at 30 weeks gestation, the uterine fundal height was 30 centimeters, that would typically indicate a normal or expected level of fetal growth.
In those cases where, prior to 30 weeks, there is a marked disparity between the gestational age and uterine fundal height, abnormal fetal growth may be suspected. Because uterine fundal height measurements are at best, inexact, safe and careful obstetricians will typically use such measurements as a very rough guide to assess fetal growth.
More detailed measurements of fetal growth and development can be obtained through ultrasonography. Through ultrasonography, various measurements of fetal biometrics can be obtained, including the biparietal diameter of the fetal head, femur length and abdominal circumference. Such measurements, when compared to standardized indexes, can reveal the extent to which a baby may be suffering from fetal growth restriction.
Upon the assessment of fetal growth restriction, a safe and careful obstetrician will usually attempt to determine the etiology or cause of the fetal growth restriction so that an effective and appropriate management plan can be implemented.
There are several maternal conditions that are strongly associated with the development of fetal Intrauterine Growth Restriction.
Any maternal condition which results in uteroplacental insufficiency, that is, a reduction in nutrients and oxygen delivery from the mother’s placenta to the baby, can also result in fetal Intrauterine Growth Restriction.
Such conditions typically include maternal hypertension, both chronic hypertension and the severe hypertensive illness known as pre-eclampsia and maternal diabetes mellitus.
Several abnormalities of the placenta are also associated with the development of fetal IUGR. Partial placental abruption, wherein the placenta partially separates from the uterus, is also recognized as a likely cause of fetal Intrauterine Growth Restriction.
In many cases, where the placenta is abnormally small, the baby will suffer fetal Intrauterine Growth Restriction.
In attempting to determine the cause or etiology of fetal Intrauterine Growth Restriction, many safe and careful obstetricians will utilize a test known as doppler velocimetry. Through doppler velocimetry, an obstetrician can determine the volume and rate of blood flow through the umbilical cord from the mother’s placenta to the baby. In those cases where the doppler velocimetry reveals restrictions in either volume or rate of blood flow through the umbilical cord of a growth restricted baby, an appropriate plan of management can be developed which may typically include the prompt delivery of the baby.
Upon the assessment of fetal Intrauterine Growth Restriction, many safe and careful obstetricians will refer their patients to maternal-fetal specialists, doctors who have special training and expertise in the management of patients whose baby’s suffer from Intrauterine Growth Restriction.
In addition to assessing the likely cause or etiology of the fetal Intrauterine Growth Restriction, safe and careful obstetricians will also initiate a regimen of fetal surveillance to routinely assess the status of the baby up through the time of delivery.
Such fetal surveillance tests typically will include weekly nonstress tests, biophysical profiles and serial ultrasound examinations to assess the level of amniotic fluid and to determine the level of fetal growth.
Because of the extreme risk associated with moderate to severe fetal Intrauterine Growth Restriction, many safe and careful obstetricians will deliver their patients prior to term via cesarean section.
The Law Firm of Dugan, Babij, Tolley & Kohler, LLC has extensive experience in representing families whose loved ones have died or been injured as a result of medical malpractice associated with the management of fetal Intrauterine Growth Restriction.