Intrauterine Growth Restriction (IUGR)

Intrauterine growth restriction is a disorder whereby an unborn baby is smaller than his/ her expected weight because the foetus is not growing at a normal rate inside the mother’s womb. Usually, foetal weight below the tenth percentile, as indicated with the help of an ultrasound, is considered to be intrauterine growth restriction. Often, a baby who is not as big as expected may be so because of the stature of the parents, and will be perfectly normal. Such foetuses are said to be ‘constitutionally small’. 

There could be numerous causes of IUGR, the most common being problems with the placenta, which is the tissue joining the mother to the foetus and which supplies oxygen and nutrients to the baby. If the placenta has not developed or isn’t attached properly, the foetus may not be able to grow properly. Other possible causes include:

  • Umbilical cord abnormalities​

  • Gestational diabetes in the mother

  • Low levels of amniotic fluid

  • Drug abuse, smoking or alcohol consumption by the mother during pregnancy

  • Infections passed on by the mother

  • Health problems or disorders in the mother, such as sickle cell anaemia, heart disease or high blood pressure, kidney or lung disease

  • A malnourished or anaemic mother

  • Living in high altitudes

  • Multiple pregnancies

Depending on the cause of intrauterine growth restriction, a foetus may be small all over (symmetric IUGR), or his/ her head may be normal while the rest of the body may be small (asymmetric IUGR).​

A pregnant mother may or may not be able to feel that her baby is as big as it should be. Specifically, the baby’s weight is below the tenth percentile (which means the weight is less than 90% of foetuses of the same age and gender) according to the gestational age – the age measured in weeks that shows how far along the pregnancy is. 

Associated signs and symptoms besides the low gestational weight include:​

  • ​Small overall appearance

  • A small body, except the head which is of the normal size

  • Thin and dull umbilical cord

  • Low uterine fundal height, which is the measurement from the mother's pubic bone to the top of the uterus 

Most of these symptoms may not be visibly obvious, but can be seen in an ultrasound or can be observed through a physical examination of the pregnant mother. ​

You should see your obstetrician working with the Women’s Health Care Service Line at The Aga Khan University Hospital regularly throughout the pregnancy, including all follow-up visits as the baby’s weight is monitored throughout the pregnancy. If at any point you feel that the baby is not growing enough, you must seek immediate medical consultation with one of the internationally trained Neonatologists working with the Children’s Hospital Service Line at The Aga Khan University Hospital to receive expert professional advice and additional information. 

The risk of pregnancy and newborn complications increases in babies diagnosed with IUGR, depending on the cause. Earlier diagnosis will help your doctor recommend the most suitable treatment plan to cure the problem to ensure a healthiest possible pregnancy for you and your child.​

Your time with your doctor may be limited, so make sure to prepare for your visit beforehand. Here are some tips to help get you started.​​

Intrauterine growth restriction is confirmed with the help of an ultrasound which shows the size of your uterus during pregnancy, as well as measurements of the baby’s head and abdomen inside the womb and also how much amniotic fluid is there. 

Measurement from the top of the uterus to the pubic bone is another measure of assessing whether the baby is growing inside your womb. This measurement must correspond with the gestational age of the baby. 

Other methods of ensuring that the baby is gaining weight as expected include:

  • Weight checks of the mother, with weight gain being an indicator of the growth of the baby

  • Foetal monitoring of the baby’s heartbeat

  • Testing of the amniotic fluid

  • Doppler flow test to check the flow of blood in the umbilical cord and vessels in the baby's brain.

These tests will help identify any infection or genetic problems that could be causing intrauterine growth restriction.

​​The Laboratory Services at The Aga Khan University Hospital, are equipped with state-of-the-art equipment and devices for diagnosing IUGR if it may be suspected. You must follow the instructions recommended by your doctor for diagnostic tests to help reach an accurate diagnosis about what could be causing intrauterine growth restriction in your baby.​​

The treatment for IUGR will depend on the cause diagnosed, and also on how far along are you in your pregnancy. The following treatment options may be recommended:

  • If you are over 34 weeks pregnant, an induction for earlier delivery may be recommended

  • For babies less than 34 weeks in gestational age, foetal monitoring, including amniotic fluid monitoring will be continued till 34 weeks. In case the symptoms do not improve, an earlier delivery may be suggested

Although early delivery may be necessary, the doctor will first try to keep the baby safe in the womb for as long as possible.

Mothers may be advised to eat more calories and cut down on aerobic exercise, especially if the mother’s weight gain is also not at par with expectations. Mothers who smoke and drink will also be advised to give up smoking and drinking if they haven’t given it up already. You must follow through on all appointments for monitoring your baby’s weight. Talk to your doctor in detail about any treatment plan recommended for you before you consent to any treatment option.​

The Aga Khan University Hospital offers various support services to help with managing or recovering from the disease or condition. These include but are not limited to nutrition, physiotherapy, rehabilitation, specialized clinics and some patient support groups. Your doctor or nurse will advise you accordingly.

The Aga Khan University Hospital offers financial assistance to those who are in need and fulfil the eligibility criteria. For further information, you can contact the Patient Welfare Department. You can find the contact number of the Patient Welfare Department in the ‘Important Numbers’ section on the website homepage.​

The financial counselling staff is available during office hours, at the main PBSD (Patient Business Services Department), to answer your financial queries on treatments’ costs and authorize admissions on partial deposit as per hospital policies allow. The financial counsellor in the emergency room is open 24/7. You can find the contact number of the Patient Business Services in the ‘Important Numbers’ section on the website homepage.​​

Your doctor and or nurse will give you specific instructions about the prescribed medication. Please ensure that you take or use the prescribed medicine as advised. It can be dangerous to your health if you self-prescribe. Please inform the doctor or nurse beforehand if you have experienced any adverse reactions to any medications in the past. If you experience any symptoms of drug poisoning, overdose or severe reaction please contact the Pharmacy Service at The Aga Khan University Hospital immediately. You can find the contact number of the Pharmacy Services in the ‘Important Numbers’ section on the website homepage.​

​The information provided on our website is for educational purposes and not intended to be a substitute for medical advice, diagnosis or treatment. You should always seek the advice of your doctor or other healthcare professional provider.