Intrauterine fetal growth retardation

Prematurity (immaturity) should not be confused with intrauterine growth retardation (IUGR): babies of these two different types differ from each other in the number of problems that arise after birth.

Causes of intrauterine growth retardation. Growth-retarded infants (small or lightweight for their age) are those whose birth weight is 10 centigrade below normal. Predisposing factors include multiple pregnancies; malformations; infection, maternal smoking; diabetes; arterial hypertension (for example, with the development of preeclampsia); severe anemia; heart and kidney disease. About 10% are mothers who give birth to only small children. In the presence of placental insufficiency, the newborn has a relatively small head circumference (since the life support of the fetus was insufficient).

Prenatal diagnostics. Almost 50% of causes cannot be identified before birth. Measuring the height of the fundus above the pubic symphysis is a fairly accurate method for quantitatively assessing fetal growth, especially if the centile assessment scale is used. Weak maternal weight gain suggests intrauterine growth retardation (from the 30th week of pregnancy, the mother should gain 0.5 kg/week). Low water and weak fetal motor activity also indicate placental insufficiency. If fetal growth retardation is suspected, it is advisable to monitor the fetal head and abdominal circumference using ultrasound examinations. Up to the 32nd week of pregnancy, the head circumference normally exceeds the abdominal circumference, but from the 32nd week, the abdominal circumference should increase faster than the head circumference. Placental function should be monitored. If the results of the Doppler ultrasound examination of the blood flow in the umbilical cord are normal, then the outcome of pregnancy with intrauterine growth retardation is more favorable (less likely to cause premature birth and miscarriage). The mother should be advised to stop smoking, note and record fetal movements, and observe a rest regimen.

Childbirth and postnatal care. A fetus with intrauterine growth retardation is more susceptible to hypoxia, so labor should be closely monitored. Adequate temperature control is extremely important after birth, so infants weighing less than 2 kg should be cared for in an incubator. Since such a fetus is in a state of hypoxia in utero, the hemoglobin content in the blood increases in compensation, and neonatal jaundice is often observed later. Such infants have relatively small glycogen reserves, and therefore they are susceptible to hypoglycemia. These newborns should be fed in the first 2 hours after birth and the blood glucose level should be measured before each feeding, which is done at 3-hour intervals. If the newborn, despite regular feeding, still develops hypoglycemia, he or she is transferred to a specialized department. Such infants are more susceptible to infection. After birth, it is usually possible to establish the causes of intrauterine growth retardation.

The difference between intrauterine growth retardation and prematurity (fetal immaturity). Up to 34 weeks, the fetus does not have rudiments of mammary glands, then they begin to develop, their diameter increases by 1 mm / week. The ear cartilage develops between the 35th and 39th weeks, so the ears of premature babies do not straighten after bending. The testicles are in the inguinal canal at the 35th week, in the scrotum - at the 37th week. In premature girls, the labia minora are open and underdeveloped (the genital slit is gaping). Normally, folds of skin on the anterior third of the surface of the foot are detected from the 35th week (on the anterior V, surface of the foot - from the 39th week, everywhere - from the 39th week). In premature babies, the skin is red, covered with hair. The vernix caseosa (original) lubricant begins to form from the 28th week, and reaches its maximum by the 36th week. Premature babies do not lie in the womb with bent limbs until the 32nd week. All their limbs bend only starting from the 36th week. With intrauterine growth retardation, the diameter of the fetus's head is relatively small.

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