Intrauterine growth restriction – what is it?
Intrauterine growth restriction (IUGR), also called fetal growth restriction (FGR), occurs when a baby does not grow as well as it should during a pregnancy. Placental insufficiency (where oxygen and nutrients are not sufficiently transferred to the fetus via the placenta during pregnancy) is one of the main causes of FGR, which can result in chronic fetal hypoxia (i.e. long lasting oxygen deprivation) leading to life-long disabilities.
IUGR can result in a number of health problems for the baby and significantly increase the risk of further complications and potential birth injuries. The most significant potential risks of IUGR are hypoxia from oxygen deprivation during the pregnancy or during delivery; meconium aspiration and low blood sugar.
During a “normal”, low risk pregnancy, a baby’s growth will be tracked. This starts at the 12 week dating scan where the sonographer will measure a baby from their head to their bottom, and then measurements will be taken of a baby’s head circumference, abdominal circumference and femur length typically at around 20 weeks during the anomaly scan. Thereafter, and from around 24 weeks, typically a midwife will then regularly check a baby’s growth by measuring the distance between a mother’s pubic bone and the top of the womb – known as the symphysis fundal height, which is essentially a measure of the size of the uterus used to assess fetal growth and development during pregnancy.
These measurements are then plotted on a customised fetal growth chart, and can help midwives and doctors identify babies who are growing too slowly or too fast more accurately, and if appropriate offer further care if needed.
Management of FGR
If there are concerns that a fetus is not growing well during a pregnancy, doctors will consider how severely the baby is affected, and will put a treatment plan in place. This may involve repeated ultrasound scans to monitor growth (as these scans are more reliable than measuring a woman’s abdomen, and show the pattern and trend of growth), examine the amount of water (liquor) around the baby and look at the blood flow through the umbilical cord. These scans check that growth is not slowing and look for other worrying features so that early delivery or other intervention can be arranged if necessary.
If early delivery is needed, then babies may need steroids to reduce the risk of problems after birth, and mothers may need to be transferred to a maternity unit with appropriate special care facilities.
Often babies that are found to have restricted growth will be delivered without complication, but there are sadly occasions where this is not the case, and if either undetected or left untreated, it can lead to neurological injury which can result in life-long disability for the child and in some circumstances stillbirth.
For expectant mothers the most important steps that can be taken to identify whether their baby is at risk of or presenting with FGR include:
- attending all scheduled antenatal appointments;
- not smoking cigarettes or drinking alcohol during pregnancy (stopping smoking before 16 weeks of pregnancy reduces a mother’s risk to the same as a non-smoker);
- undergoing the combined screening test at 12 weeks’ gestation;
- getting to know her baby’s pattern of movements and reporting any significant reduction in movements to her midwife or maternity care provider.
It is important to note that whilst a growth restricted baby who is delivered early may need some extra care on arrival, ultimately it will usually be healthy, as the monitoring in place is there to ascertain the optimum time for safe delivery. This is why it is so important that midwives and doctors correctly follow the measures put in place to identify these babies – they have a very good chance of survival and being born without injury when the correct care is delivered.
Sadly, there are circumstances where errors into the provision of care do arise. In our experience these most frequently involve:
- failing to identify a woman as being at high risk of FGR (for example, not noting a previous small baby which can put a mother at a significantly greater risk of a subsequent baby experiencing the same problems);
- failing to act on a blood test result at 12 weeks indicating the mother is at risk of developing problems with the placenta (this test is taken as part of the screening for Down’s Syndrome);
- delays between identifying potential growth restriction and referring for or undertaking a growth scan to check the baby’s size;
- failing to act on ultrasound scans which show that a baby’s weight is below the 10th centile;
- incorrect plotting of the baby’s weight on the growth chart, leading to false reassurance of the baby’s growth.
If you have a child who has suffered neurological injury and there are concerns about fetal growth restriction, it may be appropriate to seek legal advice from specialist medical negligence solicitors who have experience with child brain injury claims to see if there are grounds for a compensation claim. This is because the impact of any neurological injury is likely to be profound, and whilst bringing a claim cannot reverse the damage caused, it could make a life-changing difference in securing funds to help with funding rehabilitation and support.
Case study
Our client, Charlie, has been left with a serious brain injury following the failure to take appropriate action when there was concerns about fetal growth shown on ultrasound scan at around 28 weeks gestation. Charlie suffers with spastic quadriplegic cerebral palsy, learning difficulties and epilepsy.
Click here to read Charlie’s story https://clmedilaw.co.uk/client-stories/charlies-story-periventricular-leukomalacia/.
Amy Milner is a Senior Associate at CL Medilaw who works closely with many families with children who have acquired a brain injury due to negligent medical care. CL Medilaw are dedicated to changing the lives of their clients by making legal matters as straight forward as possible and securing early provision of support to really make a difference to the families they represent. You can contact us either by email at [email protected] or by telephone on 0345 2410 154.
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I’ve never heard of this before. My son is 35, I was told throughout pregnancy I was having a big baby. I had numerous scans as I went private. He weighed 4lb 12oz. He has CP.