Differentiation of growth retarded from normally grown fetuses and prediction of intrauterine growth retardation using Doppler ultrasound

Abstract

Objective To assess the hypothesis that infants exhibiting catch‐up growth as an indicator of intrauterine growth retardation (IUGR) have a higher incidence of predelivery abnormal Doppler results. Setting Obstetric unit, St James's University Hospital, Leeds. Participants One hundred and ninety‐six women with singleton pregnancies at high risk of IUGR, delivered between October 1992 and August 1993. Main outcome measures Postnatal catch‐up growth during the first seven months. Results Forty‐six of the 196 infants demonstrated catch‐up growth and were therefore classified as growth retarded; 85% of this group had had abnormal Doppler results prior to delivery, compared with 14% of the normally grown group. However, there is considerable overlap in birthweight ratio distribution between the two groups. Conclusion This study confirms the existence of a population of IUGR infants of average birthweight ratio. Doppler appears to distinguish IUGR (as defined by catch‐up growth) from normal growth more successfully in infants with an average birthweight ratio than in infants with a low birthweight ratio and is a better predictor of IUGR than SGA.

High Maternal Blood S100B Concentrations in Pregnancies Complicated by Intrauterine Growth Restriction and Intraventricular Hemorrhage

“…It is commonly accepted that IUGR is associated with utero-placental blood flow impairment, which may be reduced up to 50% (25 ), so that transfer of oxygen and nutrients from the mother to the fetus is diminished, leading to a cardiovascular response characterized by a redistribution of cardiac output to maintain oxygen supply to the brain, heart, and adrenals to preserve their function at the expense of visceral organs (26 ). This redistribution phenomenon, called the brain-sparing effect, correlates with the degree of fetal hypoxia and the perinatal outcome (27)(28)(29); adverse effects of hypoxemia on brain maturation have been demonstrated in clinical and histologic studies (30 -32 ).…”

Suspected Fetal Growth Restriction at 37 Weeks: A Comparison of Doppler and Placental Pathology

“…Obvious physical features of FGR in the SGA infant, uncommon with modern obstetric management, include decreased muscle mass and subcutaneous tissue and skin desquamation [3]. Other observations proposed for diagnosing FGR among SGA newborns include low ponderal index [4] and postnatal catch-up growth [5]. Current management in FGR is designed to avoid stillbirth, incidence 1.1–3.6%, and deliver the most mature baby as possible [6, 7].…”

“…Current management in FGR is designed to avoid stillbirth, incidence 1.1–3.6%, and deliver the most mature baby as possible [6, 7]. Up to 70% of fetuses with suspected FGR may be constitutionally small normal infants and may not be at increased risk for stillbirth, and the remainder (after exclusion of birth defects, congenital infections, and chromosomal abnormalities) will have FGR presumably related to a pathologic placental process [5, 8]. …”

Circulating S100β Protein Is Increased in Intrauterine Growth-Retarded Fetuses

“…IUGR is generally associated with uteroplacental blood flow insufficiency (up to 50%) because of impaired trophoblast invasion of spiral arteries, which are not transformed to low resistance vessels (11,12). Fetoplacental insufficiency, and subsequent fetal hypoxia, activates a cascade of pathophysiologic events leading to brain damage in which vasoactive agents and calcium-mediated effects are involved (13).…”