Follow along to learn more about IUGR pregnancies along with Deema’s personal experience.

What is IUGR?

IUGR also known as intra-uterine growth restriction is a rate of fetal growth that that is less than normal for the growth potential of that specific neonate. In other terms, for various reasons, the baby is not growing at a “normal” rate.

This leads to the baby being “small for gestational age” at birth in most cases. Small for gestational age is defined as being in at or less than the 10th percentile for that specific infant. 

There are three types of IUGR, asymmetrical IUGR, symmetrical IUGR and mixed IUGR. Asymmetrical IUGR means that the baby’s head and brain are the expected size, but the rest of the body is small. Symmetric IUGR indicates that the baby is small overall. 

In my case, my babies all had asymmetrical IUGR and experienced “brain sparing” meaning that cardiac output prioritizes growth to the brain and head. 

Why does IUGR happen?

Well, the short answer is that there is no short answer. IUGR occurs for a variety of reasons. It can happen due to maternal, placental, fetal, or genetic factors. Of course, a combination of theses factors is possible as well. 

The age of the mother, time between pregnancies, maternal health, behavioral factors, maternal infection, not enough nutrients being received to the placenta, so on and so forth. This study has excellent tables that break down various causes.

Management of IUGR

If an IUGR diagnosis is made prior to 32 weeks gestation, a maternal fetal medicine consult is recommended according to the ACOG. Surveillance of these pregnancies will vary to include doppler studies, non stress tests, growth ultrasounds, biophysical profiles.

Your provider will discuss an induction with you if an induction is indicated. The ACOG has an excellent break down on management in various scenarios. 

Remember, management is patient dependent. That means that it will be customized to your specific needs in order to do what is best for the baby and for the mother. 

Deema’s experience

All three of my children were small for gestational age. With my first, an OB resident noticed that my fundal height was measuring three weeks behind and she did order a single growth ultrasound.

Fundal height can vary which is why a growth ultrasound was ordered. The growth ultrasound showed an projected weight of 6lbs 13 ounces for my eldest indicating that the pregnancy was “normal.” 

At the time, I was not well versed on pregnancy management in cases like mine. I say this because if I was, I would have known that one growth scan on its own does not give us an adequate picture. Standard practice is to repeat a growth scan 3-4 weeks apart in order to get accurate data. 

I feel it is important to mention that I received my prenatal care at a resident ran clinic at the time. I had no issues with this at all, as my husband was a fourth year medical student himself. However, I did see a different provider at each appointment, meaning there was a lack of continuity of care.  

My first born was delivered at exactly 39 weeks, my membranes ruptured (water broke) and I had a vaginal delivery to a 5 lb 11 ounce baby boy. Everyone in the room was shocked with him small he was! 

Fortunately he did not have any health complications and we both went home 48 hours later. I did suffer from hyperemesis gravidarum with this pregnancy which can definitely be a contributing factor to fetal growth restriction. 

For my middle child, my daughter, I did some research and found an OB who came highly recommend at treating hyperemesis gravidarum (HG). I found her in an HG support group that I had joined on Facebook.

Unfortunately the intended pregnancy resulted in a miscarriage, otherwise known as a chemical pregnancy due to the the timeframe of the miscarriage. I became pregnant again immediately following the chemical pregnancy and continued on with that practice. 

The office took a close look at my pregnancy history and took extra measures to beware of IUGR again. I did suffer from HG again with my middle child and was diagnosed with IUGR at 32 weeks.

My OB ordered growth ultrasounds/doppler ultrasounds every two weeks and weekly non stress tests after 36 weeks pregnant. My OB explained to me that an induction could come at any point in time and I would possible need steroid shots to assist with the baby’s lungs if she would come prior to 36 weeks. 

She scheduled an induction at 38 weeks. This was determined by very specific guidelines set forth by ACOG that are calculated by the stats of the fetus and performance on non stress tests and doppler studies. She did let me know that I was at higher risk for a cesarian section due to the fact that smaller babies can experience distress with contractions. 

I was able to have a vaginal delivery and my daughter was born weighing 5 lb 3 ounces which is exactly what she was estimated to weigh. My daughter did required several weight check appointments and she had some difficulty maintaining her temperature, but we all went home 24 hours after her delivery.

She was born at the height of pandemic in July of 2020. I remember after I delivered my daughter, my OB looked at me and my husband and said she was she thankful that this pregnancy was over because she felt such anxiety after I left every appointment. 

My last pregnancy was not planned and was extremely distressing. The growth restriction was the most severe in this pregnancy. It reared its ugly head early and I was diagnosed by 20 weeks pregnant this time around.

Extensive monitoring was done along with a consult to maternal fetal medicine. We began with weekly doppler studies and non stress tests and growth scans every three weeks as the guidelines had changed since my last pregnancy. 

We ramped monitoring up to two twice a week non stress tests along with the doppler studies as the pregnancy progressed. I also received steroid shots this time around as the pregnancy was much higher risk than my previous pregnancies, indicating that early delivery was on the table. My OB mentally prepared me to deliver as early as 34 weeks. 

I was induced at 37 weeks. This decision was made by referring to the latest guidelines that were set forth by the ACOG. My OB actually had discussed a 38 week induction when I mentioned that the latest research that I had seen indicated that 37 weeks was protocol due to the specific size of my baby.

She cross referenced this and agreed. There is nothing wrong with doing your own research and advocating for yourself. Just be sure to carefully examine the sources that you are reviewing and assure that they are not only evidence based, but also up to date. 

I went in for a vaginal induction with the understanding that if at any point in time the baby showed signs of distress, we would move to an emergency c-section. 

Unfortunately my baby flipped breech a few hours before the induction. I discovered this upon bedside ultrasound. A ECV or external cephalic version was attempted and was unsuccessful resulting in an urgent c-section. 

Ultimately my son did end up immediately going to the NICU due to his low birth weight of 4 lbs and 3 ounces or 1899 grams. The cutoff at the hospital that I delivered at was 2000 grams, so he just missed the threshold. 

He spent eight days in the NICU being treated as a “feeder/grower” meaning that he was there for support around gaining weight. He did not require any type of medical intervention throughout his stay. 

I hope that this post helped explain what IUGR may look like!