A prenatal developmental disorder is called intrauterine growth retardation. Synonyms for intrauterine growth restriction are prenatal dystrophy and fetal hypertrophy.
What is intrauterine growth restriction?
Intrauterine growth retardation is usually detected during prenatal care in the second or third trimester during an ultrasound scan. A so-called fetometry is carried out with the help of ultrasound. See AbbreviationFinder for abbreviations related to Intrauterine Growth Retardation.
In the case of intrauterine growth retardation, there is a pathological delay in the growth of an unborn child in the womb (uterus). The affected children are referred to as SGA children. SGA stands for ” small for gestational age “. Intrauterine growth retardation, also known as IUGR for short, is present when the weight and size of the unborn child are below the 10th percentile.
The causes of IUGR can be genetic or influenced by environmental factors. It can be caused by the child or by the mother. Intrauterine growth retardation is usually discovered during prenatal care in the first or second trimester. Around a quarter of all stillbirths are due to intrauterine growth retardation. The growth retardation can lead to metabolic changes in the fetus, so that the affected children have a higher risk of death.
Causes
One fetal cause of IUGR is chromosomal aberration. A chromosomal aberration is a chromosomal abnormality that affects a genome. The best-known aberration is trisomy 21, also known as Down syndrome. Malformations such as agenesis or aplasia can also lead to growth retardation. When viruses are transmitted from mother to child, they can affect the development and growth of the fetus.
Transmission takes place via the placenta. Infections in the mother with rubella, toxoplasma or genital herpes pose a particularly high risk of disease for the child. However, intrauterine growth retardation can also have its origin in the placenta. A common cause of delayed growth is multiple pregnancy.
Due to the lack of space, growth deficits may occur in one or more children. Placental insufficiency also affects the growth of the child. Acute placental insufficiency is caused by acute circulatory disorders. Chronic placental insufficiency is triggered by chronic illnesses in the mother-to-be.
High blood pressure and proteinuria during pregnancy usually indicate preeclampsia. A fetal complication of preeclampsia is intrauterine growth restriction. Maternal causes of growth retardation are autoimmune diseases and kidney diseases. Gestational diabetes in the mother can also have a negative impact on the growth of the unborn child.
The fetus also grows more slowly if it receives too little oxygen. Such hypoxia can be caused by anemia, cardiovascular disease, or pulmonary disease. High blood pressure, alcohol abuse and smoking during pregnancy also damage the unborn child and lead to delayed growth. Due to the risk of intrauterine growth retardation, some medications are contraindicated during pregnancy.
Symptoms, Ailments & Signs
There are two types of IUGR. The asymmetrical form occurs in 70 percent of cases. Initially, only body weight is affected by the developmental disorder. The body size is normal, but the waist circumference is reduced. The children have too little subcutaneous fat tissue and thus develop a very small and thin body that does not match the proportion of the head.
In the symmetrical form of intrauterine growth retardation, the body weight and body length of the unborn child are reduced. The head circumference is in the right proportion to the rest of the body, but overall body growth does not correspond to the standard values. The intrauterine growth retardation can lead to drastic changes in the child’s metabolism.
These metabolic disorders can expand and worsen after birth, increasing the risk of certain chronic diseases later in life. These diseases include, for example, coronary artery disease (CHD). This phenomenon is also known as fetal programming.
Suboptimal conditions during pregnancy lead to an irreversible susceptibility to disease in the unborn child. Structural changes in organs, a changed number of cells, a changed blood supply and a changed number of cell receptors result from the intrauterine growth retardation. The children are initially able to compensate for these changes, but over the course of their lives they develop diseases more frequently than children who have not been affected by IUGR.
Diagnosis & course of disease
Intrauterine growth retardation is usually detected during prenatal care in the second or third trimester during an ultrasound scan. A so-called fetometry is carried out with the help of ultrasound. The unborn child is measured in the womb. Routine parameters include head circumference, biparietal diameter, fetal abdominal circumference, and femur length.
If there are any abnormalities, further investigations are carried out. These investigations include Doppler sonography and fetal blood gas analysis. During fetal blood gas analysis, the oxygen level in the child’s blood vessels is checked. Cardiotography is used to record and monitor fetal cardiac activity. An amniocentesis may be done. Amniotic fluid is removed from the embryonic blastocyst through a puncture of the amniotic sac.
Genetic diseases of the embryo can be clarified by special examinations of the amniotic fluid. If there is a suspicion of an infection in the mother, a TORCH serology is carried out. The TORCH complex describes various infectious diseases that can be passed on to the unborn child during pregnancy. In the laboratory, the mother’s blood is tested for toxoplasma, coxsackie virus, syphilis, HIV, parvovirus B19, listeriosis, rubella, cytomegalovirus and herpes simplex virus.
Complications
This disease results in growth retardation in the womb. As a rule, this disease leads to extreme consequential damage after birth and thus to a considerable reduction in life expectancy. First and foremost, the patients suffer from a greatly reduced body weight. Likewise, different lengths on the body can be deformed and damage to the internal organs occurs.
Metabolic disorders can also occur as a result of growth retardation and thus lead to various complications in adulthood. In most cases, the symptoms of this disease cannot be completely combated, resulting in a reduced life expectancy and a higher susceptibility to infections after the patient is born.
In some cases, the mental development of the patient is also restricted or severely slowed down by this disease. It can also lead to malformations of the heart. After birth, the growth retardation can no longer be treated causally. If the symptoms are recognized before birth, the expectant mother should avoid drugs and follow a healthy lifestyle.
This can limit further damage. If the growth retardation is caused by another disease, a premature birth may have to be initiated. This can lead to various complications.
When should you go to the doctor?
As a matter of principle, an expectant mother should take part in all preventive and check-up examinations offered during pregnancy. With these examinations, delays in the development of the embryo can be recognized and diagnosed by the doctor several months before the expected date of birth using imaging procedures.
If the expectant mother has the vague feeling that something might be wrong with the fetus or the general development during pregnancy, she should see a doctor. If the pregnancy belly grows unusually little or if the weight gain of the pregnant woman is very small, these abnormalities should be discussed with a doctor. If the expectant mother notices a peculiarity of the metabolism, it is necessary to consult a doctor. A doctor should be consulted in the event of cardiac arrhythmias, changes in blood pressure or heart palpitations. If sleep disorders occur, if there are fears or uncertainties, it is advisable to consult a doctor. If there are genetic diseases in the family, these should be discussed with a doctor and specifically clarified.
Treatment & Therapy
The therapy depends on the cause. Alcohol and nicotine consumption must be stopped immediately. One goal of therapy is to improve placental perfusion. Pregnant women often have to stay in bed after diagnosis. Inpatient admission may be required. In severe cases, labor is induced even before the 37th week of pregnancy.
Outlook & Forecast
Although intrauterine growth retardation has no consequences for the health of the mother, it has serious effects on the health of the unborn child. First of all, changes occur in the fetus’s metabolism, which ensure that physical functions cannot express themselves in line with age. As a result, the child can be born with physical and mental developmental disabilities. At best, the baby is underweight at birth and its development can be promoted by appropriate nutrition after birth, so that it no longer suffers from intrauterine growth retardation later in life.
In the worst case, the consequences result in an increased risk of certain chronic diseases that only appear later in life. For example, the risk of affected children later developing coronary heart disease is increased by intrauterine growth retardation.
If the problem is caused by an underlying disease in the fetus, the prognosis for the baby’s later life depends heavily on this underlying disease. Because it is probably born underweight and very small, it has hardly any energy reserves to cope well with the stress caused by its underlying disease. Affected babies have to be looked after and examined by a doctor soon after birth, because this is the only way to detect physical and psychological damage at an early stage and to contain the consequences for their health in good time.
Aftercare
Intrauterine growth retardation requires intensive medical care during and after pregnancy. Immediate treatment and subsequent aftercare can limit the physical damage to the infant. This is very important for the health of the child. It is important for the women affected to strictly follow the medical recommendations after the diagnosis.
Consistent bed rest is the priority here. Expectant mothers need plenty of sleep and rest. This protection has a positive effect on the course of the disease and affects both the mother and the unborn child. Stress levels should be reduced as much as possible. At the same time, physical exertion is taboo for the women concerned.
Depending on the situation, only short walks are allowed. The fresh air and light movement stabilize the physical condition and also improve the mood. This has a positive effect on the psyche and the entire condition. Diet also plays a role.
Together with the doctor, the patient should adjust the diet in order to supply the body with enough nutrients. With balanced meals, lots of vegetables and fresh fruit, the body gets the strength it needs. Too few calories, on the other hand, can have a harmful effect on the further course of pregnancy.
You can do that yourself
In everyday life there are some methods that those affected can use to help themselves. The most important thing to note is that bed rest should be observed. This applies specifically to cases where it has been prescribed by a doctor. As part of bed rest, attention should be paid to the quality and quantity of sleep. Adequate sleep is essential for protecting the sick and the unborn child, even without prescribed bed rest.
General lifestyle also plays a role. If there is a stress level, it should be reduced to a minimum if possible. In this way, the patient can be protected as much as possible. Those affected should keep any exertion to a minimum and avoid vigorous physical activity. However, this does not apply to short walks in the fresh air. These can have a positive effect on the psyche and body and thus contribute to an improvement in the condition.
The diet of the patient should also be monitored. If this is too one-sided, the diet should be changed. A suitable menu contains as balanced a diet as possible, lots of fresh fruit and vegetables. Too few calories can also be harmful. It is therefore important to ensure sufficient nutrient intake. Any nicotine or alcohol consumption should be stopped immediately after diagnosis.
