Common Obstetric Problems

Failure to thrive in the womb - intrauterine growth restriction (IUGR)
There are 4 main reasons why a fetus fails to grow or be of a normal size in the womb:
1. Constitutional - The fetus grows well but is small, because it was meant to be small (typically the parents will be relatively small also)
2. Maternal - The mother is unwell or undernourished (the most common reason for being born small and growth restricted)
3. Uteroplacental - The placenta fails to establish a good relationship with the uterus (womb). This leads to problems later in the pregnancy, when the growing fetus demands more and more oxygen and other nutrients from the placenta, which cannot deliver. The fetus fails to thrive to thrive and becomes small and growth restricted (IUGR). Ultrasound can reveal the IUGR and assess the condition of the fetus using biophysical assessment and fetal Doppler (see ultrasound).
4. Fetal - The fetus may have an abnormality that affects its growth, or it may have an infection. Part of the assessment of the IUGR baby is to look for signs of these and other problems (see ultrasound).

The management and decision regarding delivery of a small, especially growth restricted fetus, is complex and dealt with on an individual basis (see scanning in the second half of pregnancy). (continued next page)