Intrauterine growth restriction
K. Haram a,*, E. Søfteland b, R. Bukowski c
Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway Department of Anesthesia and Intensive Care, Haukeland University Hospital, and Department of Biomedicine,University of Bergen, Bergen, Norway c Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas, USA
Received 18 October 2005; received in revised form 23 November 2005; accepted 30 November 2005
Intrauterine growth restriction; Small for gestational age; Diagnosis; Treatment
Abstract This study reviewed the screening, diagnosis,prophylaxis, and treatment of intrauterine growth restriction using the PubMed database for key words and the Cochrane database for systematic reviews. Identification of risk factors and measurement of symphysis—fundus height are currently the screening standards. Diagnosis is verified by ultrasonography. Accuracy of diagnosis may be improved by using customized fetal growth curves symphysis—fundus heightcharts, and 3dimensional ultrasonographic evaluation and measuring umbilical artery Doppler dimensional ultrasonographic evaluation measuring umbilical artery Doppler impedance. Prophylaxis with acetylsalicylic acid, started in the first or second trimester or combined with heparin before conception, may reduce the incidence of growth restriction in specific groups at high risk. Active managementmay reduce incidence in patients with mild to moderate asthma, and targeted treatment of infections may also be beneficial. Antenatal corticosteroid treatment also reduces the perinatal morbidity and mortality associated with IUGR. Bed rest has no demonstrated beneficial effects. D 2006 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.1. Introduction
As intrauterine growth restriction (IUGR) has serious short- and long-term fetal consequences, it is important to distinguish between a fetus small for gestational age (SGA) and a fetus with IUGR.
* Corresponding author. Fax: +47 55 97 49 68. E-mail address: firstname.lastname@example.org (K. Haram).
Whereas the estimated weight of the former is merely less than a cut-off weightfor a given population, often because of constitutional factors, the latter has not reached its growth potential. Traditionally, IUGR screening is based on clinical examination and identification of risk factors. Maternal risk factors for IUGR include a prior pregnancy with IUGR, pre-eclampsia, a low prepregnancy weight, or a low weight gain during the
0020-7292/$ - see front matter D 2006International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2005.11.011
6 index pregnancy. Screening include abdominal palpation, symphysis—fundal (S—F) height measurement, and ultrasonographic examination. When a small fetus is detected, diagnostic signs include decreased amniotic fluid volume, abnormal umbilical artery Dopplerimpedance indexes, decreased fetal growth rate, and an abnormal fetal karyotype. The cause of IUGR should be treated whenever possible. Women with an IUGR pregnancy need appropriate surveillance and concurrent treatment of underlying disorders, e.g., hypertension or infection. The aim of this study was to assess current screening, diagnosis, prophylaxis, and therapy of fetal growth restriction.K. Haram et al. . Up to 30 weeks (60 mm), dating based on BPD measurement virtually coincided with dating obtained by Hadlock et al. using a multiparameter method . New Norwegian reference norms for BPD and HC are also similar to those in the British charts . A study of 152 singleton pregnancies conceived in vitro showed that HC was most accurate when only a single parameter was used...