INTRA UTERINE GROWTH RETARDATION (IUGR)

• IUGR is defined as lower than normal foetal growth characterized by an estimated foetal weight below the 10th percentile for a given gestational age
• Asymmetrical IUGR is caused by extrinsic influences (most commonly placental insufficiency) that affect the foetus in the later stages of gestation. It manifests with normal foetal head size with a disproportionately small body and limbs
• Symmetrical IUGR is caused by intrinsic influences (e.g., early intrauterine infections, aneuploidy) that affect the foetus in the early stages of gestation. It typically manifests with a global growth restriction of the head and body and can lead to an increased risk of neurologic sequelae

Maternal

• Constitutional - small women, maternal genetic and racial background
• Maternal nutrition
• Maternal diseases – Anaemia, hypertension, heart diseases 
• Toxins – alcohol, smoking, cocaine, heroin 

 Foetal 

• Structural anomalies
• Chromosomal abnormalities – Trisomies 13,18,21 and turner’s syndrome 
• Infections – TORCH agents, Malaria 
• Multiple pregnancies

 Placental

• Poor uterine blood flow to the placental site for a long time
• Includes Placenta Previa, abruption, circumvallate, infarction, and mosaicism

 Unknown

• 40% causes remain unknown

At birth

• Weight deficit – 600 gm below the minimum in percentile standard
• Length – unaffected
• Head circumference is relatively larger than the body in an asymmetric variety
• Dry and wrinkled skin, scaphoid abdomen, thin meconium-stained vernix caseosa, thin umbilical cord. All this gives the baby an’ old man look’ Plantar creases – well defined
• The baby is alert, active, and having a normal cry. Eyes are open
• Reflexes – normal

Symmetrical IUGR

• Height, weight, and head circumference proportional
• Commonly due to congenital infection, genetic disorder, or intrinsic factors
• Reduced number of cells in foetus
• Normal ponderal index
• Complicated with poor diagnosis

Asymmetrical IUGR

• Head larger than the abdomen
• Commonly due to uteroplacental insufficiency, maternal malnutrition, hypoxia, or extrinsic factors
• Cell number remains the same but the size is small
• Low ponderal index
• Uncomplicated, having a good prognosis

[Ponderal index= birth weight* 100/crown heel length. Typical values-20 to 25]

• Haemoglobin
• Urine – sugar, albumin, microscopy, culture, and sensitivity
• HIV
• TSH
• HBsAg
• USG
• Biochemical markers – Elevated levels of MSAFP and Hcg levels in the second trimester are markers of risk of IUGR
• Doppler velocimetry of umbilical artery – reduced or reversed diastolic flow
• No stress test: late decelerations of the foetal heartbeat, bradycardia

No proven therapy for reversing IUGR once it has established

• Adequate bed rest – especially in the left lateral position
• Correct malnutrition by balanced diet – (300 extra calories per day)
• Appropriate therapy for complicating factors likely to produce IUGR
• Avoidance of smoking, alcohol
• Maternal hyperoxygenation
• Low dose aspirin(50 mg daily)

 Ayurvedic Treatment

 Internal Medicines

• Sitha, Kasmarya, and Madhuka sidha ksheera 
• Madhuyashti, Kasmarya, Sariba, sita sidha ksheera
• Mamsarasa + Brihmaneeya dravyas and Sneha
• Balamoola Kashaya 
• Vidaryadi gritha