Background: Intrauterine growth restriction (IUGR), a condition that occurs due to various reasons, is an important cause of fetal and neonatal morbidity and mortality. This study was done to know biochemical, histopathological and radiological changes in IUGR cases with pregnancy.

Methodology & Subjects: Women who attended the Obstetric OPD in their 1^st trimester of pregnancy and those who were thought would be able to visit the antenatal clinic for their fortnightly check-up regularly were screened for intrauterine foetal growth retardation. Women with irregular and uncertain menstrual history and where the 1^st trimester USG foetal crown rump length did not corroborate with the menstrual gestational age were excluded from this study.

Results: Incidence of IUGR was 18.2% and 84% were found to be asymmetrical. IUGR was found to be double among primigravids and women above 30 years. In the present study, both clinical and ultrasonographic detection of oligohydramnios was found to be associated with IUGR. Abdominal circumference was found to be less in IUGR group than control cases from 28 weeks onwards in serial USG examination. Mean weight of placenta of IUGR babies were significantly low as compared to control group. Hb level was found lower in IUGR cases than control group. Maternal blood sugar level was relatively low at term in IUGR group. In IUGR group perinatal mortality was 2 (8%), whereas in normal pregnancy there was no perinatal death.

Conclusion: Fetuses with impaired intrauterine growth resulting from placental insufficiency are at increased risk of adverse short- and long-term outcome. Most of risk factors associated with IUGR in this study are preventable.

Keywords: Intrauterine growth restriction (IUGR); Fetus; Pregnancy; Placenta; USG; Outcomes

1. Hay WW, Thureen PJ, Anderson MS. Intrauterine growth restriction. Neo Reviews. 2001; 2:129.
2. Chatelain P. Children born with intra-uterine growth retardation (IUGR) or small for gestational age (SGA): long term growth and metabolic consequences. Endocr Regul. 2000. pp. 33–6.
3. Saleem T, Sajjad N, Fatima S, Habib N, Ali SR, Qadir M. Intrauterine growth retardation--small events, big consequences. Ital J Pediatr. 2011; 37:41.
4. Sharma D, Shastri S, Sharma P. Intrauterine Growth Restriction: Antenatal and Postnatal Aspects. Clinical Medicine Insights Pediatrics. 2016; 10:67-83.
5.  Murki S, Sharma D. Intrauterine Growth Retardation-A Review Article. J Neonatal Biol 2014; 3:135.
6. Saleem T, Sajjad N, Fatima S, Habib N, Ali SR, Qadir M. Intrauterine growth retardation small events, big consequences. Ital J Pediatr. 2011 Sep 7; 37:41.
7. Scott KE, Usher R. Fetal malnutrition: its incidence, causes, and effects. Am J Obstet Gynecol. 1966 Apr 1; 94(7):951-63.
8. Imdad A, Yakoob MY, Siddiqui S, Bhutta ZA. Screening and triage of intrauterine growth restriction (IUGR) in general population and high risk pregnancies: a systematic review with a focus on reduction of IUGR related stillbirths. BMC Public Health. 2011 Apr 13;11 Suppl 3:S1.
9. Horta BL, Victora CG, Menezes AM, Halpern R, Barros FC. Low birth weight, preterm births and intrauterine growth retardation in relation to maternal smoking. Paediatr Perinat Epidemiol. 1997 Apr; 11(2):140-51.
10. Albu AR, Anca AF, Horhoianu VV, Horhoianu IA. Predictive factors for intrauterine growth restriction. J Med Life. 2014;7(2):165–171.
11. Cunningham FG, compiler. In: Fetal Growth Disorders.Williams Obstetrics, 22nd ed., Chapter 38. New York: McGraw Hill; 2001. pp. 893–910.
12. Jahn A, Razum O, Berle P. Routine screening for intrauterine growth retardation in Germany: low sensitivity and questionable benefit for diagnosed cases. Acta Obstetricia et Gynecologica Scandinavica. 1998; 77(6):643–648. 
13. Fikree FF, Berendes HW. Risk factors for term intrauterine growth retardation: a community-based study in Karachi. Bull World Health Organ 1994; 72: 581-587.
14. Kleijer ME, Dekker GA, Heard AR.  Risk factors for intrauterine growth restriction in a socio-economically disadvantaged region. J Matern Fetal Neonatal Med 2005; 18: 23-30.
15. Dashe JS, McIntire DD, Lucas MJ, Leveno KJ.  Effects of symmetric and asymmetric fetal growth on pregnancy outcomes. Obstet Gynecol 2000; 96: 321-327.
16. Meis PJ, Michielutte R, Peters TJ, BradleyWells H, Evan Sands R, et al.  Factors associated with preterm birth in Cardiff, Wales. I. Univariable and multivariable analysis. Am J Obstet Gynecol 1995;173: 590-596.
17. Odibo AO, Nelson D, Stamilio DM, Sehdev HM, Macones GA.  Advanced maternal age is an independent risk factor for intrauterine growth restriction. Am J Perinatol 2006; 23: 325-328.
18. Mansour E, Eissa AN, Nofal LM, Kharboush I, Wagida A, Sallam I. Incidence and factors leading to Low Birth Weight in Egypt. Int. Pediatr. 2002; 17: 223-230.
19. Parker JD, Schoendorf KC, Kiely JL. Associations between measures of socioeconomic status and low birth weight, small for gestational age and premature delivery in the United States. Am. Epidemiol 1994; 4: 271-278.
20. Sharon D, Gilberto FC. Associations of intrauterine growth restriction among term infants and maternal pregnancy intendedness, initial happiness about being pregnant and sense of control, Pediatrics 2003; 111: 1171-1175.
21. Aghamolaei T, Eftekhar, Zare S. Risk Factors Associated with Intrauterine growth Retardation (IUGR) in Bandar Abbas. Journal of Medical Sciences 2007; 7: 665-669.
22. Campbell S, Newman GB. Growth of the fetal biparietal diameter during normal pregnancy. J Obstet Gynaecol Br Commonw 1971; 78:513–9.
23. Chitty LS, Altman DG, Henderson A, Campbell S. Charts of fetal size: 3. Abdominal measurements. Br J Obstet Gynaecol1994; 101:125–31.
24. Fox H. Invited review. A contemporary approach to placental pathology. Pathology 1981 Apr; 13(2):207-23.
25. Cunningham, Fetal Growth Disorders, Williams Obstetrics, 23 edn, pp: 842-858.
26. Halliday HL. Neonatal management and long-term sequelae. Best Pract Res Clin Obstet Gynaecol 2009;23: 871-880.
27. Manandhar T, Prashad B, Nath Pal MN. Risk Factors for Intrauterine Growth Restriction and Its Neonatal Outcome. Gynecol Obstet 2018, Vol 8(2): 464.
28. Nardozza LM, Araujo Júnior E, Barbosa MM, Caetano AC, Lee DJ, et al. Fetal growth restriction: current knowledge to the general Obs/Gyn. Arch Gynecol Obstet 2012; 286: 1-13.
29. Bernstein. Morbidity and mortality among very-low-birth-weight neonates with intrauterine growth restriction. The Vermont Oxford Network. Am J Obstet Gynecol 2000; 182: 198-206.
30. McIntire DD, Bloom SL, Casey BM, Leveno KJ. Birth weight in relation to morbidity and mortality among newborn infants. N Engl J Med 1999;340: 1234-1238.

Dr Sayandev Dasgupta

Associate Professor, Department of General Surgery, ICARE Institute of Medical Sciences and Research, Banbishnupur, Purba Medinipur, Haldia, West Bengal 721645, India