INTRAUTERINE GROWTH RETARDATION
Vascular insufficiency (80% of cases; better prognosis)
Vascular disease (including preeclampsia)
Placental infarction or degeneration, inc.
antiphospholipid antibody sd
Genetic Abnormalities (10%; poorer prognosis)
Chromosomal or somatic
TORCH infections (10%; poorer prognosis)
Ultrasound to evaluate fetal anatomy
Viral and chromosomal studies
Biweekly NST/BPP near term
- Bedrest (controversial)
- Delivery traditionally recommended if near term and IUGR seems progressive
- In a study in 650 women with singleton pregnancies and IUGR (abd
circ or EFW < 10%ile or flattening of growth curvesin 3rd
trimester) at > 36wks randomized to expectant management (daily
fetal movement counts and 2x/wk FHR monitoring & ultrasound) vs.
labor induction within 48h of randomization, there was no sig. diff.
in incidence of (fetal death before discharge, 5min Apgar < 7,
umbilical cord pH < 7.05, or NICU admission) or individual outcomes
within that composite outcome. (BMJ 341:c7087, 2010-JW)