Integrated Testing and Management in Fetal Growth Restriction

Polish Gynecological Society Recommendations for Labor Induction

“…About 10% of perinatal mortality is due to IUGR. The risk of perinatal death in a child with a birth weight of < 10 th percentile is twice as high as in an infant with a normal birth weight [26,27]. Obstetric management in suspected fetal growth disorders involves estimating gestational age based on the crown rump length (CRL) measured in the first trimester of pregnancy or the transverse cerebellar diameter measured in the second trimester (if the CRL is unavailable).…”

“…It should be taken into account that intrauterine growth restriction developing after 34 weeks of gestation is not always associated with abnormal umbilical blood flow; hemodynamic changes may be slightly increased and relate mainly to a reduced pulsatility index in the middle cerebral artery [26]. …”

Intrauterin Gelisme Geriligi

“…Buna karşın oligohidramniyozun eşlik ettiği, UA'da diyastol sonu akımın kaybolduğu veya ters döndüğü olgular Evre 2, duktus venozusta veya umbilikal vende ters akım bileşeni göz-lenen olgular ise Evre 3 İUGG olarak değer-lendirilir. Evre 2'de yer alan olgular, fetüsün ekstrauterin yaşama şansı varsa hastaneye yatı-rılarak ve haftada 2-3 defa tekrarlanan Doppler US incelemesi ile takip edilmelidir [20,37,38]. Doğumun doğru zamanlaması için UA Doppler bulguları yol göstericidir.…”

The role of ultrasound in the diagnosis and management of the growth restricted fetus

“…Antenatal surveillance modalities include cardiotocography, biophysical profile score (tone, movement, breathing and amniotic fluid index) and arterial and venous fetal Doppler studies. These modalities used in combination, known as integrated fetal testing, allow the most precise assessment of fetal wellbeing 28 . During this time of surveillance, maternal contributors should be minimised and medical condition optimised.…”

“…In view of the real risk of fetal acidosis and asphyxia, full multiparameter testing may be necessary up to several times per day if delivery is not planned. Absence or reversal of the DV a wave, or umbilical vein pulsations predict stillbirth with 65% sensitivity and 95% specificity 28 , and delivery – if at a viable gestation and weight – should be expedited. Interestingly, while absent / reversed a wave is a good predictor of fetal death, it does not seem to confer a worse long term neurological prognosis among survivors 35 , and others have challenged the notion that the DV is reliably associated with fetal acidosis 36 .…”