Intrauterine growth restriction: causes, diagnosis, and therapeutic approaches

The intrauterine growth restriction (IUGR) syndrome is one of the most dangerous complications of pregnancy. It significantly increases the risk of intrauterine death, leads to the birth of babies with extremely low weight, and is often accompanied by complications during the early neonatal period. The fact that IUGR often develops asymptomatically and is only detected after thorough dynamic monitoring is particularly concerning.

What is intrauterine growth restriction?

Intrauterine growth restriction is referred to when the weight of the child is below the normal values for a given stage of pregnancy. According to observations, this condition is found on average in 5 to 17.6% of pregnant women. There are three degrees of IUGR, which differ by the degree of growth restriction: from two weeks to more than four weeks.

The form of IUGR can be symmetrical or asymmetrical. In the former case, there is a uniform delay in all anthropometric parameters of the fetus, which is most often related to congenital infections or genetic anomalies. In the latter case, weight loss occurs while the length and head circumference are normal, indicating a later origin and, as a rule, placental issues.

Why does intrauterine growth restriction develop?

The causes of IUGR are multiple and can include factors related to the fetus, the placenta, or the health of the mother. Four major causal categories leading to growth restriction in utero are identified:

• Constitutional factors, meaning genetic or familial predispositions.
• Maternal medical conditions such as hypertension, diabetes, chronic cardiovascular diseases, urinary tract infections, smoking, alcohol abuse, and inadequate nutrition significantly increase the risk of fetal growth restriction.
• Fetal medical conditions such as genetic mutations, chromosomal abnormalities, and intrauterine infections all have a direct influence on the growth rate of the embryo.
• Placental factors (e.g.: chronic placental abruption, umbilical cord malformation, placenta previa, abnormal placental development, late gestation).

Diagnostic approaches

The diagnosis of IUGR is based on ultrasound data that evaluate growth rate, abdominal circumference, biometric parameters, and blood flow in the umbilical cord and placental vessels. Dopplerometry is particularly important. Serial obstetric ultrasounds of fetal parameters from the first screening also provide an objective picture.

The doctor collects medical history, assesses risk factors, monitors the fetal heart rate, and the general condition of the pregnant woman. Only systematic monitoring and regular follow-up allow for the detection of the problem at an early stage.

Treatment

The tactic depends on the cause and degree of the disturbance. In some cases, medication is necessary to stabilize blood pressure, correct glucose levels, and treat infections. In other cases, medications that improve blood circulation between the uterus and placenta are prescribed (low-dose aspirin). Hospitalization, oxygen therapy, and limitation of physical activity are sometimes indicated.

If the fetal condition worsens, a decision for premature delivery is made. In this case, it is important that the facility is prepared to provide high-tech neonatal care.

Are there differences between IUGR in women undergoing IVF?

According to recent clinical studies, certain characteristics requiring closer monitoring are observed during pregnancies resulting from in vitro fertilization (IVF). This primarily concerns cases of IVF with egg donation or IVF with double donation. However, it is important to emphasize that due to precise monitoring of the fertilization stages, embryo selection, and initial diagnosis, these pregnancies often receive closer and more qualified medical supervision from the start.

Women undergoing IVF generally undergo additional examinations, for example, more frequent ultrasounds at an advanced stage of pregnancy, which allows for timely detection of even minor developmental anomalies in the fetus. This approach ensures a high level of safety and allows for individualized management of the pregnancy, especially in the presence of additional risk factors such as age, chronic diseases, or previous pregnancies that ended in failure.

The personalized approach of the "Natuvitro" clinic

The specialists at the "Natuvitro" clinic have many years of experience in supporting IVF pregnancies. The approach is personalized for each patient: an individual examination schedule is established, all parameters of fetal development are assessed, and early prevention of placental insufficiency is implemented.

When signs of IUGR are detected, an intensive monitoring program is established with the help of specialized doctors. Modern therapeutic methods are used, including correction of blood flow, metabolic support, and, if necessary, preparation for premature delivery under conditions of complete perinatal preparation.

This approach minimizes risks and ensures the birth of a healthy child, even in the most complex clinical situations.