Intrauterine Growth Restriction (IUGR): Approach and Monitoring

Background: Intrauterine Growth Restriction (IUGR), also referred to as Fetal Growth Restriction (FGR), is a pathological condition in which a fetus fails to achieve its genetically determined growth potential, typically defined as an estimated fetal weight below the 10th percentile for gestational age. IUGR is associated with increased perinatal morbidity and mortality, including prematurity, hypoxia, stillbirth, and long-term neurodevelopmental impairment. The approach to IUGR begins with early identification through routine antenatal surveillance, including serial fundal height measurements and ultrasound biometry. Once suspected, diagnosis is confirmed using ultrasonographic assessment of estimated fetal weight, abdominal circumference, amniotic fluid volume, and Doppler velocimetry of uterine and umbilical arteries. Differentiation between constitutionally small fetuses and true growth restriction is essential for appropriate management. Monitoring strategies focus on fetal well-being and timely intervention. Serial growth scans are typically performed every 2–4 weeks. Doppler studies of the umbilical artery, middle cerebral artery, and ductus venosus provide information on placental function and fetal adaptation. Non-stress testing (NST) and biophysical profile (BPP) are used to assess fetal condition. Management decisions depend on gestational age, severity of Doppler abnormalities, and maternal condition. The timing of delivery balances the risks of prematurity against intrauterine compromise. Early-onset IUGR (32 weeks) is more common and may require delivery at term or near term. Multidisciplinary care and individualized management plans are essential to optimize perinatal outcomes. Early detection, structured monitoring, and evidence-based timing of delivery remain the cornerstone of improving outcomes in pregnancies complicated by IUGR. Conclusion: Intrauterine Growth Restriction (IUGR) is a significant obstetric condition associated with increased perinatal morbidity and mortality. Early identification through routine antenatal screening and accurate diagnosis using ultrasound and Doppler studies are essential for distinguishing true growth restriction from constitutionally small fetuses. Close and structured monitoring of fetal growth and well-being—using serial biometry, Doppler velocimetry, and fetal surveillance tests—plays a crucial role in guiding management decisions. The timing of delivery should be individualized, balancing the risks of prematurity against the risk of intrauterine compromise. A multidisciplinary and evidence-based approach, combined with timely intervention, is key to improving shortterm neonatal outcomes and reducing long-term complications in pregnancies complicated by IUGR.