Intrauterine growth restriction

Question 1

What percentage of small for gestational age infants does IUGR represent

Answer 1

IUGR represents 30% of all small for gestational age infants

Question 2

What is required for the determination of fetal growth by gestational age in the context of IUGR?

Answer 2

Determination of growth by gestational age requires standardized ultrasound (US) reporting that includes locally relevant nomograms​

Question 3

What is the first step in the diagnosis of IUGR?

Answer 3

he first step is to ascertain the reliability of pregnancy dating. This includes evaluating the history for hypertension, vascular disorders, tobacco use, recreational drug use, medications (like anticonvulsants), previous IUGR, previous abruption, placenta previa in the current pregnancy, and multiple gestation​

Question 4

What should be excluded when possible in the diagnosis of IUGR?

Answer 4

Constitutionally small fetuses should be excluded when possible​

Question 5

What clinical findings might suggest IUGR during an examination?

Answer 5

On examination, findings that might suggest IUGR include blood pressure measurement, signs of extreme malnutrition, BMI, stigmata of alcohol, tobacco, and drug use, and a fundal height (FH) measurement that is ≥ 3 cm smaller than expected for gestational ag

Question 6

What is the definition of Intrauterine Growth Restriction (IUGR)?

Answer 6

IUGR is defined as a fetus whose estimated fetal weight (EFW) is less than the 10th percentile for gestational age

Question 7

What investigations are conducted to diagnose IUGR?

Answer 7

nvestigations for IUGR include:

Ultrasound (US) for fetal anatomy, estimated fetal weight (EFW), liquor volume, and anomalies.
Regular US for fetal growth every 2-4 weeks, with the frequency depending on the precision of measurements.
Doppler velocimetry of the umbilical artery if available.
Testing for VDRL.
Screening for thrombophilias if there is early onset IUGR, early onset severe preeclampsia, thrombosis, or intrauterine fetal demise (IUFD).
Consideration of fetal karyotype if structural anomalies are present, IUGR occurs before 32 weeks gestation, IUGR is below the 3rd percentile, or there is polyhydramnios suggestive of trisomy 18​

Question 8

What factors determine the management plan for IUGR?

Answer 8

The management of IUGR is individualized and depends on gestational age (GA), severity of IUGR, maternal condition, and fetal condition​

Question 9

How is mild or moderate IUGR managed?

Answer 9

Mild or moderate IUGR is managed with daily fetal kick counts, weekly antenatal care visits, weekly non-stress test (NST) or biophysical profile (BPP) if indicated, and serial ultrasound and Doppler studies for growth and amniotic fluid volume

Question 10

What is the recommended management for severe IUGR?

Answer 10

Severe IUGR requires admission to KCH/QECH and twice-weekly NST or BPP​

Question 11

What is the management protocol for IUGR detected before 34 weeks of gestation?

Answer 11

For IUGR before 34 weeks, corticosteroids are administered, regular fetal surveillance is conducted, and delivery is planned at 34 weeks gestation​

Question 12

What is the management approach for IUGR detected after 34 weeks of gestation?

Answer 12

For IUGR after 34 weeks, immediate delivery is recommended​

Question 13

What is the preferred mode of delivery for IUGR when fetal surveillance is normal?

Answer 13

Vaginal delivery with continuous CTG monitoring is preferred when fetal surveillance is normal, with the option for immediate caesarean delivery if needed

Question 14

When is caesarean delivery indicated for IUGR?

Answer 14

Caesarean delivery is indicated if antenatal and/or intrapartum fetal surveillance is abnormal