1. IUGR
Babies whose birth weight is below the 10th percentile for their gestational age-SGA
SGA-1.CONSTITUTIONALLY SMALL BUT HEALTHY
2.TRUE IUGR
Growth restriction can occur in preterm,term or post term babies.
IUGR-symmetrical/asymmetrical

2. IUGR
symmetrical IUGR –uniform growth retardation-propotionally small.due to insult early in pregnancy-chemichal exposure,viral infection,inherent cellular developmental abnormality-aneuploidy.
assymetric IUGR-dispropotionately lagging abdominal growth,defeciency of nutrients due to chr.placental insufficiency-pre eclampsia,malnutrition.placental insufficiency-marginal/velamentous insertion of cord,circumvallate/placenta previa
Intrinsic IUGR ,extrinsic IUGR,combined IUGR, idiopathic IUGR.
Incidence of IUGR is 2%-5%.

3. History
Age-teenage and elderly gravidas-malnutrition,chronic vascular disease. Increased matenal age-^ risk of chromosomal abnormalities
High altitudes-chronic hypoxia
h/o consanguinity-since iugr is seen in congenital anomalies-cvs,renal and in familial chondrodystrophies,osteogenesis imperfecta.
possibility of fetal congenital disorder should always be considered in idiopathic/unexplained IUGR.
h/o loss of wt/absence of wt gain during pregnancy-lack of wt gain in 2nd trimester is strongly associated with decreased BW and iugr.

4. History h/o symptoms of malabsorption-steatorrhoea
h/o drug intake-warfarin/phenytoin
h/o symptoms of anaemia-fatigue,breathlessness,palpitations
In most cases anemia does not cause IUGR.exception-sickle cell anemia.

5. History h/o symptoms of pre-eclampsia-before 37 weeks
h/o symptoms suggestive of APLA syndrome-recurrent thrombotic events,recurrent pregnancy loss
h/o infections-TORCH,parvovirus-direct infection of the fetus and placenta,chronic villitis,accelerated fetal metabolism-IUGR.infection with hepatitis A/B,congenital malaria,TB,syphilis
CMV-cytolysis,loss of functional cells,rubella-vascular insufficiency due to endothelial damage

6. OBSTETRIC HISTORY-
h/o iugr/stillbirths with small fetus/h/o IUD in previous pregnancy
^ incidence of stillbirth in IUGR.20-25% of stillbirths show IUGR.
Fetal death in IUGR may occur at any time-more frequent >35 weeks
h/o chromosomal abnormalities in previous pregnancy-chromosomal abnormalities cause altered placental function-fetal malnutrition.also affects fetal growth potential

7. PAST HISTORY
h/o any chronic maternal vascular diseases-chronic hypertension,chronic renal disease,diabetes,connective tissue disorders(SLE),IDDM,sickle cell anaemia,heart disease -especially with superimposed pre eclampsia
h/o congenital cyanotic heart disases-chronic hypoxia
h/o tuberculosis,syphilis,malaria

8. h/o consumption of alcohol,IUGR found in 91% of fetal alcohol syndrome
h/o Smoking -reduced intervillous blood flow,effect of carbon monoxide & thiocyanate on fetus-decreased prostacyclin synthesis.
tobacco chewing gravidas,passive smokers also affected.
reduction in BW by gm at term
H/o heroin,morphine ,cocaine use-direct effect on fetus,maternal malnutrition

9. Examination
Small built women-racial,genetic factors-small babies-not worrisome.
Look for maternal malnutrition-major cause in developing countries
Maternal weight during pregnancy remains stationary or falls.
Look for anemia,cyanosis,icterus,
Signs of pre-eclampsia-edema,hypertension
There is absence of normal trophoblastic invasion of the spiral arteries in cases of IUGR-similar to pre-eclampsia.the extent of this abnormality and the maternal compensatory mechanisms will determine manifestation as pre-eclampsia,IUGR,or both.
CVS-evidence of heart disease

10. Examination
Early establishment of gestational age-careful mesurement of uterine fundal height throughout pregnancy.
Fundal ht is a reasonably accurate screening method to detect SGA fetuses-40% of such fetuses are identified.
b/w weeks-symphysiofundal ht jn cm coincides with weeks of gestation.if measurement is 2-3 cm less than expected-IUGR may be suspected.
P/A-reduction in fundal ht - fundal ht falls below the 10th percentile

11. Examination
Abdominal girth measurement shows stationary or falling values
Oligohydramnios due to chronic placental insufficiency-uterus full of fetus.
Cause of oligohydramnios-decreased urinary output caused by redistribution of bloodflow with preferential shunting to the brain and decreased renal perfusion
Mild iugr-amniotic fluid may be normal.
When AFI is normal,incidence of iugr-5%.when AFI was decreased incidence of iugr-40%
Look for evidence of IUGR in multiple pregnancy-iugr of 1 or more fetuses is seen in 21% of the cases.reasons-abnormal placentation,abnormal placental vascular anastomoses.more seen in monochorionic placentation.