Asymmetrical intrauterine growth restriction is a type of intrauterine growth restriction (IUGR) where some fetal biometric parameters are disproportionately lower than others, as well as falling under the 10th percentile. The parameter classically affected is the abdominal circumference (AC).
Please, refer to the article on symmetrical intrauterine growth restriction for a particular discussion of this other type of IUGR.
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Epidemiology
It tends to present more in the 3rd trimester (later than the symmetrical IUGR pattern) and is the more common of the two primary types of IUGR.
Associations
The incidence of concurrent karyotypic abnormalities is low (or minimal 3), especially if asymmetrical IUGR is detected late in pregnancy.
Syndromes that can give an asymmetrical IUGR picture include:
Pathology
Classically, in this type, there is relative preservation of the fetal brain (fetal head sparing theory), which is pathologically characterized by an increased brain-to-liver ratio (BLR) 2. This can also result in decreased fetal subcutaneous fat 4,6. A rare paradoxical situation is with maternal cocaine use, where the head circumference (HC) is reduced out of proportion to other biometric parameters 5.
Etiology
placental insufficiency: one of the commonest causes of asymmetrical IUGR
Radiographic features
Antenatal ultrasound
Features in the classical situation include:
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changes in fetal biometric parameters
fetal abdominal circumference (AC) is classically reduced out of proportion to other fetal biometric parameters and is below the 10th percentile
certain fetal biometric parameters such as the biparietal diameter (BPD) and head circumference (HC) may be normal
increased HC:AC ratio
fetal tachycardia (may be present in up to 50% of cases 4)
Oligohydramnios may be present as an additional sonographic feature.
Treatment and prognosis
Asymmetric IUGR has a better prognosis than symmetric IUGR 10.