Dr. Rose's Peripheral Brain--INTRAUTERINE GROWTH RETARDATION

INTRAUTERINE GROWTH RETARDATION

I. Causes:

Vascular insufficiency (80% of cases; better prognosis)

Poor nutrition

Tobacco, cocaine

Vascular disease (including preeclampsia)

Placental infarction or degeneration, inc. antiphospholipid antibody sd

Multiple gestations

Genetic Abnormalities (10%; poorer prognosis)

Chromosomal or somatic

TORCH infections (10%; poorer prognosis)

II. Workup:

Ultrasound to evaluate fetal anatomy

Viral and chromosomal studies

Biweekly NST/BPP near term

III. Treatment:

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)