Physical features of IUGR baby at birth

In IUGR (intrauterine growth retardation), the baby fails to grow at the expected rate during the pregnancy. After birth, the physical features of IUGR baby are following -

• Weight deficit at birth about 600 gm and below. Every hospital have their own birth weight-gestational age chart.
• Length is unaffected.
• Head circumference is relatively larger than the body.
• Physical features show dry and wrinkled skin because of less subcutaneous fat.
• The baby is alert, active and having normal cry, eyes are open.
• Reflexes are normal.

Related  Articles :

• What is Intrauterine growth retardation (IUGR)
• Causes of IUGR
• Causes of premature labour
• Multiple pregnancy (Twins)
• Causes of ectopic preganancy (Tubal pregnancy)
• Factors responsible for abortion
• Mechanism of birth
• Diagnosis of pregnancy in first trimester

Causes of IUGR

The causes of fetal growth restriction can be divided into four groups :

1. Maternal

2. Fetal

3. Placental

4. Unknown

Maternal -

• Small woman have small babies. These babies are not at increased risk.
• Maternal nutrition before and during pregnancy -: As most of the fetal weight gain occurs behind 24th week of pregnancy. Malnutrition, anemia and oxygen deficiency during significant role in the reduction of the birth weight.
• Toxins -: Alcohol, smoking, cocaine, heroine, drugs.
• Maternal diseases -: Anemia, hypertension, heart disease, chronic renal failure.

What is Intrauterine growth retardation (IUGR)

IUGR is said to be present in those babies whose birth weight is below the 10th percentile of the average for the gestational age. In other way, it is poor growth of a baby in the mother's uterus during pregnancy.


Incidence - 

The incidence among term babies is about 5% and that among post term babies is about 15%.


Types -

Based on clinical evaluation and ultrasound examination the fetuses are divided into two types :

• Fetuses that are small and healthy -                                                                          The birth weight less than 10th percentile for the gestational age. They have normal subcutaneous fat and usually uneventful neonatal course. 

• Fetuses where growth is restricted by pathological process (true IUGR) -                   Depending upon the relative size of their head, abdomen and femur. The fetuses are subdivided into two types :

What is Superfetation and Superfecundation

Superfetation - 
Superfetation is the fertilization of two ova released in different menstrual cycles. Ovulation is usually suspended during pregnancy time to prevent chance of fertilization of other ova. If an ovum is released after the female was already pregnated, there is a chance of second pregnancy. This is called superfetation. The nidation and development of one fetus over another fetus is theoretically possible until the decidual space is obliterated by 12 weeks of pregnancy.

Management of twin pregnancy

Early management of twin pregnancy is important to prepare the parents by giving the special and advice. This will help to mother to take additional care not only for her own benefit also for the fetuses.

Advice -

• Diet – Increased dietary supplement is needed for increased energy supply to the extent of 300 Kcal per day, over and above that needed in a single pregnancy.

• Rest – Increased risk at home and early cessation of work is advised to prevent preterm labour and other complications.

• Supplement – Additional vitamins, calcium and folic acid are to be given, over and above those prescribed for a singleton pregnancy.

• More antenatal visit should be advised.

• Fetal growth assessment must be done at 2-3 week.

Hospitalization –

The woman may be admitted around the 32^nd week if she prefers it. This result in increase birth weight of babies, decreased frequency of preeclampsia, decrease frequency of preterm labour and lowered perinatal mortality.

Causes of genesis of twins

The exact cause of twinning is not known. The frequency of monozygotic twins remains constant through the globe and is probably related to maternal environmental factors. It is the wide variation in the prevalence of dizygotic twins which is responsible for the fluctuation in the overall incidence of twins in different populations. Possible causes are following :

1. Superfetation is the fertilization of two ova released in different menstrual cycles. The nidation and development of one fetus over another fetus is theoretically possible until the decidual space is obliterated by 12 weeks of pregnancy.                                                                                                                                                

Description of genesis of twins

                                  Genesis of twins

A. Dizygotic twins - 

Dizygotic twins results from fertilization of two ova, most likely ruptured from two distinct graafian follicles usually of the same or one from each ovary, by two sperms during a single ovarian cycle. Their subsequent implantation and development differ little from those of a single fertilized ovum.

B. Monozygotic twins (identical) -

The twinning may occur at different periods after fertilization and this markedly influences the process of implantation and the formation of the fetal membranes. After the fertilization, the following possibilities may occur -

• If the division takes place within 72 hours after fertilization (prior to morula stage) the resulting embryos will have two separate placenta, chorions and amnions (diamniotic - dichorionic or D/D)

• If the division take place between the 4th and 8th day after the formation of inner cell mass when chorion has already developed - diamniotic monochorionic twins develop (D/M).

• If the division occur after 8th day of fertilization when the amniotic cavity has already formed, a monoamniotic - monochorionic twins develops (M/M).

• Rare occasion, division occurs after two weeks of the development of embryonic disc resulting in the formation of conjoined twins called siamese twins. Four types of fusion may occur -

       i) Thoracopagus - conjoined twins at the thorax.

       ii) Pyopagus - conjoined twins at the posterior site.

       iii) Craniopagus - twins joint at the head.

       iv) Ischiopagus - twins joint at the ischeum.


Related articles :

• Multiple pregnancy (Twins)
• Causes of genesis of twins
• Management of twin pregnancy
• What is Superfetation and Superfecundation