Nursing care
Intrauterine Growth Restriction nursing care: what to assess and what to do first
Written and reviewed by Dana Whitfield, RN, MSN · 5 min read · Updated September 2026
Short answer
Intrauterine growth restriction means a fetus is not growing to its genetic potential, usually from placental insufficiency, and the classic clinical sign is fundal height lagging about three centimetres behind the gestational date. After birth, these newborns are watched closely for hypoglycaemia and hypothermia because they have little fat to draw on.
What it is and why it happens
Intrauterine growth restriction, or IUGR, describes a fetus whose estimated weight falls below the tenth percentile for gestational age, or that fails to follow its own established growth curve. It is distinct from a fetus that is simply constitutionally small, the concern in IUGR is a fetus failing to reach the growth potential it would otherwise have.
Placental insufficiency is the leading mechanism: a placenta that cannot deliver enough oxygen and nutrients starves the fetus of the substrate needed for growth. Maternal conditions that compromise placental perfusion, such as chronic hypertension, pre-eclampsia, and smoking, are common contributors, along with maternal malnutrition and certain infections or chromosomal abnormalities in the fetus itself. IUGR is classified as symmetric, when the whole fetus is proportionally small from an early insult, or asymmetric, when the head is spared relative to the body because the insult occurred later and the fetus redirected blood flow to protect brain growth.
How it presents — what you will actually see
The sign you will see repeatedly across antenatal visits is fundal height measuring behind gestational dates, classically lagging by about three centimetres or more. A single lagging measurement can be a dating error, but a persistent or widening gap across visits is the pattern that prompts ultrasound confirmation.
On ultrasound, estimated fetal weight falls below the tenth percentile, and Doppler studies often show abnormal blood flow in the umbilical artery, reflecting the placental insufficiency driving the restriction. Amniotic fluid volume is frequently reduced alongside IUGR, since a fetus with limited perfusion produces less urine, so oligohydramnios and IUGR are often assessed together rather than separately.
Nursing assessment priorities
Measure and document fundal height at every visit with a consistent technique, since the value of this measurement lies in tracking the trend over time, not any single number. Flag a lag of three centimetres or more, or a growth curve that plateaus, for follow-up ultrasound rather than waiting for the next scheduled scan.
Once IUGR is confirmed, prioritise fetal surveillance: non-stress tests, biophysical profiles, and umbilical artery Doppler studies at the frequency the treating team sets. Assess maternal blood pressure closely, since chronic hypertension and pre-eclampsia are common companions to placental insufficiency, and ask about fetal movement patterns at every contact, since a mother's report of reduced movement in an IUGR pregnancy warrants prompt evaluation rather than routine reassurance.
Interventions and what to do first
Reinforce the surveillance schedule and make sure the mother understands why visits and scans are more frequent than a typical pregnancy, since unexplained intensification of monitoring can feel alarming without context. Support any modifiable contributors identified, such as smoking cessation resources or blood pressure management, as part of the plan.
At delivery, anticipate that the fetus may not tolerate labour well, given the underlying placental insufficiency, so continuous fetal monitoring is the priority once labour begins. After birth, the first nursing action is thermoregulation: dry the newborn immediately, place skin-to-skin or under a radiant warmer, and check blood glucose promptly, because these infants have minimal subcutaneous fat and glycogen stores and can drop temperature and glucose fast.
Complications to watch for
Antenatally, the complication to watch for is fetal compromise from ongoing placental insufficiency, which can progress to abnormal Doppler findings, non-reassuring fetal heart tracings, or stillbirth if unaddressed, making the surveillance schedule non-negotiable. Oligohydramnios frequently accompanies IUGR and adds cord compression risk on top of the growth concern.
In the newborn, hypoglycaemia and hypothermia are the two complications to anticipate immediately after birth, both stemming from minimal fat reserves. Watch too for polycythaemia, since chronic fetal hypoxia in utero can stimulate excess red blood cell production, and for meconium aspiration risk if the fetus experienced hypoxic stress during labour. These infants also carry longer-term risk for developmental concerns, which is why paediatric follow-up is arranged before discharge rather than left open-ended.
Patient teaching before discharge
Teach the parents to recognise hypoglycaemia and hypothermia signs in their infant before they leave: jitteriness, poor feeding, lethargy, or a baby who feels cool to the touch, and make sure they know these can appear even after a period of apparent stability in hospital.
Explain frequent feeding as a specific strategy for this infant, not generic newborn advice, since regular feeds are how glucose stability is maintained once the baby is home. Confirm that paediatric follow-up is scheduled to track catch-up growth, and if a maternal contributor such as hypertension or smoking was identified, make sure the mother's own follow-up plan is equally clear before discharge.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our maternity and newborn practice questions are the closest set to what this page covers.
Common questions
What is the classic sign of IUGR on a nursing assessment?
Fundal height measuring behind gestational dates, typically lagging by about three centimetres or more, is the classic clinical sign that prompts further investigation. A single measurement can reflect a dating error, so a persistent or widening lag across visits is what confirms the pattern.
Why is placental insufficiency the main cause of IUGR?
The placenta delivers the oxygen and nutrients the fetus needs to grow, and when perfusion is compromised, by chronic hypertension, pre-eclampsia, or smoking among other causes, the fetus cannot access enough substrate to grow normally. This is why maternal vascular health is assessed alongside fetal growth in these pregnancies.
Why are IUGR newborns at risk for hypoglycaemia?
These infants have minimal glycogen and fat stores built up in utero because growth itself was restricted, leaving them with little reserve to draw on after birth. Blood glucose is checked promptly after delivery and frequent feeding is used to maintain stability.
How is IUGR different from a constitutionally small baby?
A constitutionally small fetus is growing steadily along its own curve and reaching its genetic growth potential, just at a smaller scale. In IUGR, the fetus is failing to reach the growth it should have, usually because something, most often placental insufficiency, is limiting it.
Why does oligohydramnios often accompany IUGR?
A fetus with reduced placental perfusion produces less urine, and fetal urine is the main source of amniotic fluid later in pregnancy. This is why the two conditions are frequently assessed together and why cord compression becomes an added risk in IUGR pregnancies.