Intrauterine Growth Restriction (IUGR) or Fetal Growth Restriction (FGR) is when a baby stops growing or growth slows down during pregnancy, resulting in a baby who is smaller than expected. This is sometimes referred to as a Small for Gestational Age baby (SGA). This is a relatively common problem that Tommy’s, a national pregnancy charity, estimates impacts 10% of pregnancies.
What can cause my baby to stop growing?
FGR most often occurs when the placenta is not working properly so it cannot provide the baby with the nutrients it needs to grow. It can also be caused by infections such as cytomegalovirus (CMV) or toxoplasmosis.
Your risk of having a baby affected by FGR are increased if:
- You have previously had pre-eclampsia or a stillbirth
- You’ve had heavy bleeding earlier in your pregnancy
- You have a low PAPP-A result (this is a protein produced by the placenta which helps keep it working properly – you will be tested for this when your first bloods are taken during your pregnancy)
- You have been smoking, drinking alcohol or using drugs during your pregnancy, or
- You are over 35 years old (i.e. a geriatric pregnancy).
You can reduce the risk of having a baby affected by FGR by eating healthily, not drinking alcohol or using drugs, stopping smoking and taking vitamins during your pregnancy. However, this does not guarantee that the risk of having an FGR baby will be reduced completely. Sometimes a baby’s growth will simply slow down or stop and there is nothing you or anyone else could have done to stop this.
If my baby is smaller than expected, what care will I receive and what options do I have?
If you are thought to be at risk of having an FGR baby at the start of your pregnancy, you may be recommended to take aspirin from the 12th to your 36th week of pregnancy. You may also have regular ultrasound scans to check your baby’s growth during your third trimester. You should be advised of the risks of FGR occurring so that you are part of the decision-making processes throughout your pregnancy.
When you attend your screening scan at around 12 weeks, a growth chart (graph) should be created and put in your medical records so that each time your baby’s growth is measured, it can be plotted on the graph and concerns recognised more easily. Your baby’s growth should show as a consistent curve on the chart. If the line plotting your baby’s growth suddenly changes (either dropping or increasing significantly) this should be investigated further.
In all pregnancies from approximately 24 weeks, your bump will be measured with a tape measure at each medical appointment by your midwife and/or doctor, which helps to monitor your baby’s growth. This is called the symphysis fundal height or ‘SFH’.
If your midwife or doctor become concerned during your pregnancy that you might have FGR, you will likely be referred for a scan to more accurately assess your baby’s size and health. Some other checks may also be carried out, including checking the blood flow in the umbilical cord and checking the fluid around your baby.
If FGR is confirmed, you should be monitored throughout the rest of your pregnancy to keep a close eye on your baby and make sure that they are continuing to get nutrition through the umbilical cord and growing appropriately.
You should also monitor your baby’s movements and report any reduction in movement to the hospital immediately.
It is likely that if your baby continues to be small, you may need to give birth before your due date. The exact date recommended will depend on how well your baby is coping with the pregnancy. Your doctor should discuss this with you in detail, including the risks and benefits of when to give birth and the way in which you give birth (for example an induction vs a caesarean section). Some babies might need some extra help in a neonatal intensive care unit (NICU) if they are premature or very small.
We are medical negligence experts
At Enable Law, we have a specialist neonatal and baby loss team helping families whose baby was injured at birth or who have suffered a stillbirth. Through our cases, we know the impact a missed or not properly monitored or managed FRG can have. If you are worried that your FGR may not have been treated properly, or if your baby died as a result of it, one of our experts would be happy to have a free confidential discussion with you and help you get answers on what may have gone wrong. Contact us to arrange an appointment.
