INTRAUTERINE

GROWTH
RETARDATION
 Supervised by
DR. MOHAMED EL-NEGIRY

By
NUR IZATI BINTI AHMAD SUHAIMI (5092)
NUR ‘AWATIF MADIHAH AB RAHIM (5095)
MOHD FAZRIN BIN MOHD ANUAR (5148)
NUR ASYILAH AHMAD SHARIPUDIN (5149)
 OVERVIEW
• A condition in which a fetus is unable to achieve its
genetically determined potential size.
• This excluding the fetus that are small for gestational
age (SGA) but not pathologically small.
• Out of all cases of growth under 10th percentile, 40% are
at high risk of potentially preventable perinatal death.
• 40% are constitutionally small.
• 20% intrinsically small secondary to a chromosomal or
environmental etiology.
• The clinician's challenge is to identify IUGR fetuses
whose health is endangered in utero because of a
hostile intrauterine environment and to monitor and
intervene appropriately.
• This challenge also includes identifying small but healthy
fetuses and avoiding iatrogenic harm to them or their
mothers.
• So basicly, Intrauterine growth restriction (IUGR)
describes a fetus that has not reached its growth
potential because of genetic or environmental
factors. Small for gestational age (SGA) refers to an
infant whose birth weight was below the 10th percentile
for the appropriate gestational age.
 DEFINTION
• Infant’s weight that is less than the 10th
percentile of its gestational age.
• It is suspected when the fetal size is less
than the gestational age.
 ETIOLOGY

Chromosomal and Uteroplacental

Intrauterine infections Maternal factors
genetic disorder vascular insufficiency
Chromosomal
• Down’s syndrome
and genetic • Turner’s syndrome
disorder
• Renal agenesis

• Cytomegalo virus
Intrauterine
infections • Rubella
• Syphilis
 • Malnutrition (chronic infection, worm infestation,
malabsortion syndrome, wasting disease)
• Narcotic drug addiction
Maternal • Cigarette smoking
factors • Ionizing radiation
• Anemia
• Rh-isoimmunization

• Hypertension
Uteroplacental • Diabetes
• Chronic renal disorder
vascular • Partial abruptioplacenta
deficiency • Multiple pregnancy
• Post-term pregnancy
 TYPES
TYPE SYMMETRICAL (20%) ASYMMETRICAL (80%)
Onset Early Late
Causes • Congenital infections • Uteroplacental
• Genetic disorders insufficiency
• Maternal malnutrition
• Hypertension

Pathophysiology • Impaired cell division • Impaired cellular

• Decreased cell number hypertrophy
• Irreversible • Decrease cell size
• Reversible

Clinical pictures • Affect all body including
organs and brain
• Inadequate growth of head
and body
• Head to abdomen ratio maybe
normal
• Affect body only not the
brain (sparring effect)
• Head is big in comparison
to body

Prognosis Poor More favourable

 DIAGNOSIS

HISTORY EXAMINATION INVESTIGATION

 • Of any etiological factor such as infections
History ,chronic malnutrition and systemic diseases.

• Maternal weight
• Fundal level
Examination • Oligohydraminos
• General examination of underlying causes .
• Neonate : signs of dysmaturity

• Ultrasonography
• Daily fetal movement count
Investigation • Antenatal cardiotocography
• Biophysical profile
 ANTENATAL

MANAGEMENT

INTRANATAL POSTNATAL
 Bed rest left Mode of delivery Identification and

Postnatal
Intranatal
Antenatal
lateral position influenced by management of
Discourage 1)Gestational age fetal dysmaturity
smoking as -
2)Stress test
Monitoring fetal 1) Hypothermia
3)Malpresentation
wellbeing ,antepartum 2) Hypoglycemia
Treatment hemorrhage etc . 3)
underlying cause Hypocalcaemia
TOP: intrauterine Caesarean 4) Asphyxia
asphyxia against section if fetus neonatarum
prematurity cant tolerate
reduced oxygen 5) Hemorrhagic
supply and birth tendency
trauma during 6) Stunted
vaginal delivery growth and
mental
retardation
Thank You