Maternal and fetal factors associated with non detection of fetal growth restriction at term: a retrospective study

Atiya Aziz, Shyamji Tiwari, Madhusudan Dey, Suneeta Singh


Background: Fetal growth restriction (FGR) is one of the major factors of perinatal morbidity and mortality. Aim was to study the maternal and fetal risk factors associated with non- detection of fetal growth restriction.

Methods: A retrospective analysis was done at a tertiary care hospital. 280 term newborn cases weighing <2.5 kg were selected and they were divided into two groups, Group I- FGR detected cases by ultrasound, and group II- FGR non detected cases. Data was collected from the labour room registers.

Results: Incidence of FGR found to be 6.8%.The maternal biological factors found to be significantly associated with fetal growth restriction were gestational hypertension, chronic hypertension and anemia. Fewer ANC visits was associated with non-detection of FGR cases. Detection of FGR cases were more if the birth weight found to be <2 kg when compared to non detection of FGR cases.

Conclusions: Anaemia and fewer ante natal visits were associated with non detection of FGR at term when compared with antenatally detected FGR patients.


Anemia, Ante natal checkup, Birth weight, Fetal growth restriction, Term pregnancy

Full Text:



R.K.Creasy and R.Resnik,“Intrauterine growth restriction,”in Creasy and Resnik’s Maternal-Fetal Medicine: Principles and Practice ,R.K. Creasy, C.J.Lockwood, R.Resnik, T.Moore,J.D. Iams, and M. F. Greene, Eds., pp. 743–755, Elsevier Health Sciences,Philadelphia,Pa,USA,2014.

C. Sheridan, “Intrauterine growth restriction: diagnosis and management,” Australian Family Physician, vol. 34, no. 9, pp. 717–723,2005.

Suhag A, Berghella V. Intrauterine Growth Restriction (IUGR): Etiology and Diagnosis. Curr Obstetr Gynecol Rep. (2013) 2:102–11. doi: 10.1007/s13669-013-0041-z

Society for Maternal Fetal Medicine Publications Commitee, E.Berkley, S.P.Chauhan, and A. Abuhamad, “Doppler assessment of the fetus with intrauterine growth restriction,” American Journal of Obstetrics & Gynecology,vol.206,pp.300–308,2012.

.Lappen JR, Myers SA. The systematic error in the estimation of fetal weight and the underestimation of fetal growth restriction. Am J Obstetr Gynecol. (2017) 216:477–83. doi: 10.1016/j.ajog.2017.02.013

J. Gardosi, V. Madurasinghe, M. Williams, A. Malik, and A. Francis,“ Maternal and fetal risk factors for stillbirth: population based study,” BMJ, vol. 346, article f 108,2013.

R.A. Salam, J.K.Das, and Z.A.Bhutta ,“Impact of intrauterine growth restriction on long-term health,” Current Opinion in Clinical Nutrition and Metabolic Care,vol.17,no.3,pp.249–254, 2014.

ACOG practice bulletin no. 202: gestational hypertension and preeclampsia. Obstet Gynecol 2019; 133: e1–e25.

International Association of Diabetes and Pregnancy Study Groups consensus panel (IADPSG) International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycaemia in pregnancy. Diabetes Care. 2010;33(3):676–82.

Z. Alfirevic, T. Stampalija, and G. M. L. Gyte, “Fetal and umbilical Doppler ultrasound in high-risk pregnancies,” The Cochrane Database of Systematic Reviews, vol. 11, Article ID CD007529,2013.

L.Bricker,J.P.Neilson,andT.Dowswell,“Routine ultrasound in late pregnancy (after 24 weeks’ gestation),” Cochrane Database of Systematic Reviews,no.6, Article ID CD001451,2008. no.12, pp. 1154–1158,2005.

Sinja Alexandra Ernst, Tilman Brand,A nna Reeske, Jacob Spallek et al. Care-Related and Maternal Risk Factors Associated with the Antenatal Non-detection of Intrauterine Growth Restriction: A Case-Control Study from Bremen, Germany . Hindawi BioMed Research International Volume 2017, Article ID 1746146, 10 pages

Braunthal S, Brateanu A. Hypertension in pregnancy: Pathophysiology and treatment. SAGE Open Med. 2019;7:2050312119843700. Published 2019 Apr 10.

Acharya D, Nagraj K, Nair NS, Bhat HV. Maternal Determinants of Intrauterine Growth Retardation: A Case Control Study in Udupi District, Karnataka. Ind J Commun Med 2004 Oct-Dec;29(4):181-2.

Ferraz EM, Gray RH, Cunha TM. Determinants of preterm delivery and intrauterine growth retardation in north-east Brazil. Int J Epidemiol. 1990 Mar;19(1):101-8.

Figueras F, Caradeux J, Crispi F et al. Diagnosis and surveillance of late-onset fetal growth restriction. AJOG 2018. 218(2): s790-802e1.

Boers KE, Vijgen SM, Bijlenga D, et al. Induction versus expectant monitoring for intra- uterine growth restriction at term: randomize equivalence trial (DIGITAT). BMJ 2010;341: c7087.