Intrauterine growth restriction(IUGR): Causes & Work-ups

The IUGR and the SGA are interrelated and actually mixed, but not synonymous. IUGR is defined as the case where the growth of the fetus is inhibited by various causes and is defined as the case where the expected weight of the fetus according to the gestational age is less than the 10th percentile. On the other hand, SGA means that the birth weight of newborn when birth is below the 10th percentile of body weight distribution according to gestational age. Therefore, even if IUGR was present, it may not be the SGA depending on the timing and degree of its occurrence. IUGR is observed in 3-10% of total pregnancies and in 20% of still babies. Placenta dysfunction is the most common cause, with congenital infection (10%), chromosomal abnormalities and other genetic diseases accounting for 5-15%. Factors related to IUGR can be divided into maternal related factors, placental factors, and fetal factors. Maternal side factors include experience with drug use, malnutrition, hypoxia, hypertension, infertility, spontaneous abortion, genetic, age, race, etc. Placental factors include placental infarction, chorioamnionitis due to infection, Cell count, decreased surface area, placental separation, and twin transfusion syndrome. Fetal factors include genetic abnormality, chromosomal abnormalities, radiation, multiple pregnancy, pancreatic anaphylaxis, and the like. IUGR can be classified into symmetric type and asymmetric type. Symmetric type is defined as having less than 10th percentile of height and weight according to gestational age and asymmetric type having less than 10th percentile of ponderal index. The characteristics of each classification are as follows. Early onset is likely to be symmetrical and late onset asymmetrical depending on the time of insult. The asymmetric type is understood to be a genetically unfavorable growth if the growth stopped in the middle due to environmental factors. Thus, asymmetry is a result of brain sparing due to hypoxic rearrangement of blood flow, and the development of the head is markedly lower than the development of the trunk, while the symmetric type exhibits a normal ponderal index. Causes Also asymmetric type is pregnancy addiction, chronic hypertension, kidney disease, etc. Symmetric type, genetic cause, chromosomal abnormalities, and congenital infection.

Work-ups
The treatment of IUGR is carried out in the following order. First, we look for the cause of IUGR through neonatal consultation, medical history, and physical examination, and check for any accompanying problems or complications. Hypothermia should be prevented and CBC and POCT should be used to check for any pathologic findings such as polycythemia, thrombocytopenia, and hypoglycemia. In addition, if there is suspicion in history or medical examination, it is evaluated whether congenital infection such as TORCH. Chromosomes and genetic tests can be performed, and placental pathology tests help to diagnose infarction or congenital infection. Careful follow-up is required afterwards.

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