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Intrauterine Growth Restriction (IUGR)

Extracted from Survival Guide to Midwifery, 2nd Edition (2012) Diane M. Fraser and Margaret A. Cooper, Oxford; Churchill Livingstone: 2012. Courtesy Elsevier

Failure of normal fetal growth caused by multiple adverse effects on the fetus.

Fetal growth is regulated by maternal, placental and fetal factors, any or all of which can be implicated in IUGR.

Asymetric (acute) growth is when weight is reduced out of proportion to length and head circumference. It is thought to be caused by extrinsic factors such as pregnancy-induced hypertension.

  • Head looks disproportionately large in relation to body
  • Head circumference is usually within normal parameters
  • Bones are within gestational norms for length and density
  • Anterior fontanelle may be larger than expected
  • Abdomen looks sunken (due to shrinkage of liver and spleen)
  • Decreased fat deposition
  • Skin is loose and appears wizened or 'old'
  • Vernix caseosa is reduced or absent
  • Unless severely affected, these babies appear hyperactive and hungry

Symetric (chronic) growth is due to decreased growth potential of the fetus as a result of congenital infection or chromosomal/genetic defects (intrinsic) or extrinsic factors occurring early in gestation, e.g. effects of maternal smoking, or poor dietary intake).

  • Head circumference, length and weight are proportionately reduced for gestational age
  • Babies are diminutive in size
  • They do not appear wasted and have subcutaneous fat appropriate to their size
  • Skin is taut
  • Babies are generally vigorous and less likely to be hypoglycaemic or polycythaemic
  • They may suffer major congenital abnormalities and can be a source of infection to carers as a result of transplacental infection.

Further reading

Medscape. Goss M. (2015) Fetal growth restriction. Available at:

Tidy C. (2013) Intrauterine Growth Restriction (Professional reference). Available at:


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