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Intra uterine growth restriction and stillbirth

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CESDI 8th Report
Intra uterine growth restriction

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None of the current classifications (Wigglesworth, Aberdeen, Fetal and infant) identify those stillborn babies that are growth restricted. They seek to determine cause, which is often not possible. Growth restriction is not a cause of death but may represent an underlying placental insufficiency resulting in fetal demise. Failure to detect and to act on growth restriction was frequently cited in both the 1in 10 and the Euronatal enquiries as suboptimal care.

The Aberdeen classification does divide unexplained deaths into those greater than or equal to 2.5kg and those less than 2.5kg. However this does not distinguish between those babies that are constitutionally small and those that are truly growth restricted and have failed to reach their growth potential. It is possible to customise a baby’s weight according to the physiological variables that affect growth potential; maternal height, weight, parity and ethnic group (Reference1). This identifies those babies that are truly at risk from poor outcome (Reference2).

The Institute is proposing an alternative classification system ReCoDe (Reference3) that identifies the most relevant factor at the time of death rather than cause of death, and includes fetal growth restriction as defined by customised standards. Using this system the CESDI administrators at the perinatal institute have classified the first 200 stillbirths in the West Midlands for 2001.

By the Wigglesworth classification 70% were “unexplained”

Of these 49% remained unexplained on all classification systems – however if reclassified by ReCoDe 61% of these were due to IUGR leaving only 15% unexplained in total.

This is useful when counselling couples after a stillbirth but also suggests that If we can identify growth restriction and act on it in time, these stillbirths may be avoided.


1. Gardosi J, Chang A, Kalyan B, Sahota D, Symonds EM. Customised antenatal growth charts. Lancet 1992; 339:283-287.

2. Claussen B, Gardosi J, Frances A, Cnattingius S. Perinatal outcome in SGA births defined by customised versus population-based birthweight standards. Br J Obstet Gynaecol. 2001; 108:830-834.

3.Gardosi J, ReCoDe. Br MFM Society 2001.

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