Small for Gestational Age (SGA)
(SGA) babies are those
whose birth weight below the
10th percentile for that
gestational age , which is not
Not all IUGRs are below 10th
centile ,and not all those below the
10th centile are IUGRs.
Why the fetus is small?
Failure of the fetus to
achieve its growth
Significance of IUGR
• Major cause of neonatal morbidity and
• Significant cost in terms of the
• There is a growing appreciation that
certain adult diseases (including
hypertension and diabetes) are related to
Causes of IUGR
1- maternal factors
2- placental factors
3- fetal factors
high blood pressure
chronic kidney disease
autoimmune disorders: SLE, thrombophilia,
Drugs: ACE inhibitors, substance abuse
Multiple gestation, twin, triplet, etc..
singleton Dichorionic monochorionic
Growth 5% 10 % 20 %
Types of IUGR:
2. Symmetrical (20%)
Types of IUGR
Asymmetrical( brain sparing)
- the fetus is usually with normal potential
- Mostly caused by fetal hypoxia
- seen in cases where fetal access to
nutrients is compromised, such as with
severe maternal nutritional deficiencies or
- Normal HC, and abnormal AC
Symmetrical ( all parameters involved )
- Usually the fetus loses its potential
- all fetal structures (including both head
and body size) are proportionately
diminished in size
- Mostly caused by chromosome
abnormalities congenital anomalies and
A 38-year-old G4P3 at 33 weeks gestation
is noted to have a fundal height of 29
centimeters on routine obstetrical visit. An
ultrasound is performed by the maternal
fetal medicine specialist. The estimated
fetal weight is determined to be in the fifth
percentile for the estimated gestational
age. The biparietal diameter and
abdominal circumference are concordant in
size. Which of the following is associated
with this type of growth restriction?
a. Nutritional deficiencies
b. Chromosome abnormalities
d. Uteroplacental insufficiency
Complications of growth restriction
Metabolic changes in fetus
Abnormal fetal heart patterns.
Abnormal Doppler studies.
Intra uterine fetal death.
Meconium stained liquor.
Increased incidence of
instrumental and caesarean
1- related to hypoxia and acidosis:
a- meconium aspiration.
b- persistent fetal circulation.
c- hypoxic ischemic encephalopathy.
d- hyperviscocity syndrome
3- related to the etiology:
a- chromosomal abnormalities.
b- congenital anomalies.
c- fetal infection
Possible long term complications:
Learning and behavioral problems .
Hypertension and Ischemic Heart
Metabolic disorders(type 2 D.M).
A 26-year-old G1 at 37 weeks presents to
the hospital in active labor. She has no
medical problems and has a normal
prenatal course except for fetal growth
restriction. She undergoes an
uncomplicated vaginal delivery of a
female infant weighing 1950 g. The infant
is at risk for which of the following
Modify lifestyle habits.
Magnesium & Foliate supplements decrease
rate of SGA
Quit smoking, alcohol, & drug abuse
Detect and treat medical disorders
Correction of anemia.
Control any chronic illnesses (anti-
phospholipids syndrome , sickle cell disease,
DM, HTN, thyroid dysfunction )
Regular antenatal care
Serial fetal growth assessment.
Fetal surveillance & serial US
measurements at three weekly intervals
Fetal weight every 2 weeks
Serial fetal wellbeing assessment.
3-Umblical artery Doppler
Betamethasone administration between
Timing of delivery : to maximize
gestation without the fetus suffering
any neurological abnormality, and
increasing maturity as possible
Mode of delivery.
Main danger is neurological injury
Some will suffer morbidity or die
as a result of prematurity .
Height and weight curves remains
slightly below 50th centile .
Infants with IUGR secondary to
placental insufficiency show “catch
up” growth after delivery when
feeding is optimized.
New researches suggest a link
between IUGR and birth weight and
increased incidence of HTN and
diabetes in adults
16-year-old is admitted to the labor ward
at 36 weeks gestation. She gives a
history suggestive of rupture of
membrane and is experiencing uterine
contractions. She didn’t attend for
antenatal care. She smokes 20
cigarettes/day. A caesarean section is
performed and a male infant weighing
1900 g is delivered.
Discuss risk factors for SGA in this case
Discuss complications related to IUGR in