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What is fetal growth restriction?

When your baby during your pregnancy does not grow as expected, there may be a problem. When we evaluate growth of babies, we do it with ultrasound and we measure the head, the abdomen and the femur (thigh bone). All these numbers give us an estimate of how big your baby is. Then we plot the weight of the baby on a curve which tells us where your baby is at, compared to all others at the same time in pregnancy. For example, if your baby’s weight is on the curve at the 40th centile, that means that comparatively, 40% of other normal babies at this time in pregnancy would be smaller than him/her and 60% would be bigger.

If your baby’s weight is under the 5th centile, that may mean that he/she has fetal growth restriction and a specialist should be consulted.

What are the causes?

Most of the time, fetal growth restriction (FGR) occurs because the placenta has not developed normally and/or is not functioning well. This may result in :

  • Insufficient gas exchange (including oxygen) and nutrients delivery to the baby
  • Insufficient blood flow to the baby

What are some of the risk factors for fetal growth restriction?

  • Pre-pregnancy weight (below 45Kgs)
  • Poor nutrition
  • Alcohol and drug abuse
  • Smoking
  • Pulmonary and cardiovascular diseases
  • Kidney diseases
  • Diabetes
  • Anemia
  • High blood pressure
  • Pre-eclampsia
  • Twins, triplets etc..
  • Uterine malformation
  • Intrauterine infection
  • Chromosomes abnormalities
  • Previous fetal growth restriction
  • Family history of fetal growth restriction
  • Placental anomalies such as abruption, abnormal insertion of the umbilical cord etc..
  • Having only one umbilical artery in the cord of the baby

What are the symptoms?

There are usually no symptoms associated with this condition except perhaps in certain severe cases, a reduction in the amount of fetal movements. Most of the time, this will be detected because of an abnormal size of your uterus (too small) when measured by your doctor/midwife at your regular prenatal visits. This should be followed by an ultrasound evaluation.

What are the complications?

  • Caesarean delivery could be needed
  • Premature delivery may be required with its associated complications
  • Difficulty for the baby to handle the stresses of vaginal delivery
  • Low blood sugar in the newborn
  • Abnormally high red blood cell count (baby)
  • Decreased oxygen level (baby)
  • Low resistance to any infections (baby)
  • Meconium aspiration (baby)
  • Body temperature not maintained (baby)
  • Increased risk of possible type 2 diabetes and hypertension later in life for your child

What test do we use?

  • Ultrasound is used to confirm that the size of the baby is small
  • We measure the blood flow in the umbilical cord. The method used is called Doppler

What is the role of ultrasound?

  • Check for anomalies or malformation of the baby
  • Estimation of baby’s weight
  • Assess the well being of your baby

What treatments are available?

  • Administration of steroids if premature delivery is required
  • Delivery could be necessary

Can we predict FGR?

Similarly to pre-eclampsia, some of the results of your IPS (prenatal screening test) can be helpful in predicting your risk of fetal growth restriction. As such, we encourage you to consider being tested.

In both preeclampsia and fetal growth restriction, it is essential that your placenta is examined by a competent pathologist after your delivery. This helps understand why the complication happened and may even help dictate the management in a future pregnancy.

Last updated on: November 18th, 2016