Doctor Consultation for Low Fetal Weight

Low fetal weight, also known as intrauterine growth restriction (IUGR) or fetal growth restriction (FGR), occurs when a baby is smaller than expected for its gestational age. This is typically identified when the estimated fetal weight falls below the tenth percentile on growth charts. Regular ultrasound monitoring during prenatal visits is the primary tool for detecting this condition.

IUGR can be classified as symmetrical or asymmetrical. In symmetrical IUGR, all body measurements are proportionally small, often indicating a problem that started early in pregnancy such as a genetic condition or infection. Asymmetrical IUGR, where the head is relatively spared while the abdomen is small, is more common and usually related to placental insufficiency in the later stages of pregnancy.

The condition is significant because babies with low fetal weight are at increased risk of complications during delivery and in the neonatal period. These include difficulty tolerating labour, low blood sugar after birth, temperature regulation problems, and long-term developmental concerns. Early detection and appropriate management are essential for optimising outcomes.

Placental insufficiency is the most common cause of IUGR, particularly in the third trimester. When the placenta cannot deliver adequate oxygen and nutrients to the baby, growth slows. Conditions that affect placental function include preeclampsia, chronic hypertension, blood clotting disorders, and advanced maternal age.

Maternal factors that contribute to low fetal weight include poor nutrition, severe anaemia, smoking, alcohol use, and certain chronic diseases. Infections such as toxoplasmosis, cytomegalovirus, and rubella can also impair fetal growth. In India, maternal undernutrition remains a significant contributing factor, particularly among women from disadvantaged socioeconomic backgrounds.

Fetal factors such as chromosomal abnormalities, congenital heart defects, and multiple pregnancies can also result in growth restriction. Identifying the underlying cause helps the doctor determine the most appropriate management strategy and counsel the parents about expected outcomes.

When low fetal weight is suspected based on fundal height measurements or clinical assessment, a detailed ultrasound scan is performed. This measures the baby's head circumference, abdominal circumference, and femur length to estimate weight. Serial measurements taken over time provide a more accurate picture than a single assessment.

Doppler ultrasound of the umbilical artery is an important tool in evaluating babies with suspected IUGR. It assesses blood flow from the placenta to the baby and helps determine the severity of the growth restriction. Abnormal Doppler patterns indicate compromised placental function and may influence decisions about the timing of delivery.

Additional tests such as amniotic fluid assessment, maternal blood tests for infection and clotting disorders, and fetal monitoring through non-stress tests or biophysical profiles may be recommended. A comprehensive evaluation helps the healthcare team develop an individualised management plan.

Management of IUGR depends on the severity, the gestational age, and the underlying cause. Mild growth restriction with normal Doppler findings may be managed with increased monitoring, including twice-weekly non-stress tests and weekly ultrasound assessments. The mother may be advised to rest more and maintain good nutrition and hydration.

When Doppler studies show abnormal blood flow patterns, more intensive surveillance is required. Hospitalisation may be recommended for continuous monitoring, and the timing of delivery becomes a critical decision. The doctor balances the risks of prematurity against the risks of leaving the baby in a compromised environment.

Antenatal corticosteroids may be administered to accelerate fetal lung maturation if early delivery is anticipated. This preparation is crucial for reducing complications in premature babies. The decision to deliver is made by the obstetric team based on a comprehensive assessment of maternal and fetal status.

While medical monitoring addresses the clinical aspects of IUGR, nutritional support can play a complementary role. Ensuring that the mother is consuming adequate calories, protein, iron, and other essential nutrients supports whatever placental function remains. Doctors in Visakhapatnam may refer mothers to dietitians for personalised dietary guidance.

Bed rest, while once widely recommended, is no longer universally advised. However, reducing strenuous physical activity and prioritising rest can help direct blood flow to the uterus and placenta. The doctor will advise on the appropriate level of activity based on the individual situation.

Babies diagnosed with IUGR are ideally delivered at a hospital with a well-equipped neonatal intensive care unit. This ensures that specialised care is immediately available if needed. The mode of delivery, whether vaginal or caesarean, is determined by the baby's condition, position, and the mother's health status.

After birth, IUGR babies require careful monitoring for low blood sugar, temperature instability, feeding difficulties, and jaundice. The neonatal team works closely with the parents to provide the care needed for the baby to thrive. With appropriate management, many babies with IUGR catch up in growth and development during infancy and early childhood.