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IUGR: When the Fetus Does Not Develop in the Womb

Prospective mothers certainly want a fetus in the womb that is healthy and growing well. But unfortunately, not all pregnancies can run just fine. Intra-Uterine Growth Restriction or IUGR is a pregnancy complication that causes the fetus to not develop fully in the mother's stomach.

IUGR is a condition that causes stunted fetal growth in the womb. IUGR is characterized by the size and weight of the fetus that is not by what should be based on the age of the pregnancy.

The fetus is said to not develop in utero and IUGR experience when the weight is below the 10th percentile for the average weight should be at every gestational age. Poor fetal weight can also be called small for gestational age (SGA).

Pregnancy




This means that IUGR babies are smaller than normal babies at the same gestational age. The stunted growth of the baby in the womb can cause certain health risks during pregnancy, childbirth, and after the baby is born.

What causes IUGR?

IUGR has many causes. A common cause of IUGR is a placental disorder that makes it not function properly. Positioning the placenta too low in the uterus (placenta previa) can also increase the risk of the fetus not developing.

This condition can also occur as a result of certain health problems in the mother, such as:

  • Preeclampsia and high blood pressure during pregnancy
  • Kidney disease, diabetes, heart disease, anemia, lung disease, and blood clotting disorders that occur since before and during pregnancy.
  • Fetal abnormalities, such as Down syndrome, chromosomal abnormalities, anencephaly, and kidney defects.
  • Smoking, drinking alcohol, and using drugs since before and during pregnancy.
  • Diagnosed with sexually transmitted diseases such as toxoplasmosis, rubella, and syphilis that can be transmitted to the fetus in the womb
  • Malnutrition (deficiency or excess nutrition) during pregnancy that can inhibit growth.

The risk of IUGR is also higher in women who:

  • Pregnant twins or more
  • Currently using anticonvulsant drugs for nerve disorders.
  • Have less weight or below the normal weight.
  • Live in the highlands such as hilly or mountainous areas.

What are the types of IUGR?

There are two types of IUGR. Each type reflects the conditions experienced by the fetus in the womb.

1. Symmetrical or primary IUGR

Sympathetic IUGR is a proportional fetal growth restriction. That is, the overall body size of a small fetus is below average, including the size of organs in the body.

2. Asymmetric or secondary IUGR

Asymmetric IUGR is a condition that causes the fetus to not develop evenly. That is, the size of the head and brain of the fetus are normal according to the age of the womb, but other body parts are smaller than they should be.

This type of IUGR is difficult to determine early in pregnancy. New possibilities can be diagnosed until the fetus is in the third trimester of pregnancy.

What are the signs and symptoms of IUGR?

The main symptom of IUGR is the size and weight of the fetus below the average weight should be based on the age of the womb.

The fetus is said to not develop due to IUGR when it weighs below the 10th percentile or is less than 90% by weight of a normal fetus.

Other features that can indicate the baby is not developing in the womb because of the IUGR are:

  • The fetus does not move
  • The results of the first and second-trimester ultrasound showed no progress
  • Maternal HCG levels decrease
  • Baby's heart doesn't beat

After birth, an IUGR baby can display characteristics of pale, dry, and loose skin. The umbilical cord looks thin and has a dull color.

What are the health risks to the fetus with IUGR?

A fetus that does not develop optimally during the womb will be prone to health problems at birth. Especially for fetuses weighing under 5 to 3 percentiles. They will be more likely to have more health complications in the short and long term after birth.

These various health problems are caused by the small size of the fetus so that it will receive less oxygen and nutrients while in the womb.

Furthermore, there are several risks of complications and other health problems that mothers and babies may experience if they experience IUGR. Among them:

  • Childbirth by cesarean section. This is because the baby cannot stand the pressure when the mother gives birth normally.
  • A fetus that does not develop optimally in the womb will usually have low blood sugar levels. Later he will be more susceptible to infection and may experience jaundice at birth.
  • Small fetuses are more susceptible to meconium aspiration, a condition when the fetus inhales its feces in the uterus.
  • Low baby Apgar score. The Apgar Score is a test given after birth to evaluate the physical condition of the newborn and determine the need for special medical care.
  • The number of red blood cells in a baby is very high. In the most severe cases, IUGR can cause a baby to be born dead as a result.

Some research also shows that babies with IUGR are more likely to develop diseases such as cerebral palsy, heart disease, obesity, diabetes and high blood pressure as adults later.

How do doctors diagnose IUGR?

IUGR is a pregnancy complication that can be diagnosed in several ways. One of the simplest and most common methods is to measure the distance from the mother's fundus (the top of the uterus) to the pubic bone.

Generally, the distance between the fundus and the mother's pubic bone will correspond to the development of gestational age after the 20th week. If the length is inappropriate or shorter, this possibility indicates that the fetus is not developing optimally in the mother's womb.

Other procedures for diagnosing IUGR and assessing a baby's health include:

1. Ultrasonography

IUGR can be diagnosed through an ultrasound or ultrasound test when checking the uterus.

Ultrasound works by using sound waves to create images of the baby to enable the doctor to see the baby's condition in the womb.

Ultrasound examination can be used to measure the baby's head and abdomen. The doctor can compare these measurements with growth charts to estimate fetal weight.

Ultrasound examination can also be used to determine how much amniotic fluid in the uterus. IUGR is one condition that can be characterized by the least amount of amniotic fluid in the uterus.

2. Using Doppler

Doppler is a technique that uses sound waves to measure the amount and speed of blood flow through blood vessels. The doctor can use this test to check the blood flow in the umbilical cord and blood vessels in the baby's brain.

3. Weight check

The doctor will routinely check and record the mother's weight in every obstetric check. If the expectant mother does not gain weight, it can indicate growth problems. For one thing, the fetus does not develop optimally.

4. Monitor the fetus

This test involves placing a sensitive electrode in the mother's stomach. The electrodes will be connected by a lightweight elastic band and attached to the monitor. Sensors on the electrodes will measure the speed and pattern of the baby's heart rate to be displayed on the monitor.

5. Amniotic test or amniotic fluid test

IUGR can also be diagnosed through an amniotic test. The doctor will use a special instrument that is inserted into the uterus to take a sample of fetal amniotic fluid.

This test can detect infections or some chromosomal abnormalities that can cause the fetus to not develop due to IUGR.

The size of a small baby is not necessarily due to the IUGR

Babies born under 7 pounds are not always certain because of an IUGR. About a third of babies born in the world with a low weight do experience IUGR during pregnancy, but the rest do not.

Similar to the weight of children and adults, babies born or still in the womb also have different sizes and weights.

A baby with a small weight may be caused by a history of heredity. It is possible that his siblings or parents were also born with a low weight. Usually, your obstetrician measures the size of your baby when routine pregnancy checks using ultrasound.

Your doctor will also measure the size of the lining of the pregnant woman's stomach in each trimester to check the growth and development of the fetus in the womb is healthy or not.

It is very important to accurately calculate the first day of your last menstruation so your doctor can know for sure your current pregnancy. If you fail to say the exact date, measurement of fetal weight and estimated the due date of delivery will fall apart, which may also create complications.

How to treat a fetus with IUGR?

If your pregnancy is 34 weeks or more, your doctor will generally recommend giving a faster birth by induction. Whereas if the gestational age is still less than 34 weeks, the doctor will continue to monitor until the gestational age enters the 34th week or more.

Fetal body development and the amount of amniotic fluid will also be monitored in late pregnancy. Also, some treatments that can be done to treat IUGR are:

  • Improve the nutrition intake of pregnant women

Several studies have shown that improving diet and nutritional intake of pregnant women can increase weight gain and fetal growth.

  • Total rest

The doctor will advise the mother to rest, both at home or in the hospital. Full rest can help improve blood circulation to the fetus.

How to prevent IUGR in the fetus in the womb

The best way to prevent a fetus from having an IUGR is to avoid the risk factors, as mentioned above. The mother must also ensure that the fetus grows healthy in the next 9 months by following the doctor's advice.

Here are some tips for maintaining a healthy pregnancy and the womb:

1. Eat nutritious food

Pregnant women must be highly nutritious food so that the fetus does not fail to develop in the womb. Foods that are mandatory for mothers to eat are healthy fatty fish, pasteurized milk, green vegetables, and fruits.

2. Taking prenatal vitamins

Pregnant women should consume at least 400 micrograms (mcg) of folic acid every day. This can help prevent problems with your baby's brain and spinal cord. Apart from food, additional folic acid can also be obtained from prenatal vitamins prescribed by a doctor.

3. Exercising

Exercise is important to maintain the health of the body of the mother and fetus in the womb. Exercise can train the heart rate to increase blood circulation and oxygen to the fetus. Exercise for 30 minutes a day with safe choices such as swimming, yoga or a leisurely walk. In addition to maintaining healthy content, exercise can also reduce stress during pregnancy.





References

References

  1. American Pregnancy (2019). Intra urine growth restriction.
  2. Mom junction (2019). 12 serious cause of IUGR.

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Health and clinical interests include all aspects of infectious diseases

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