Survey on the Current Trends in Managing Intrauterine Growth Restriction

Abstract

Objective: To provide a snapshot of the current trends in managing intrauterine growth restriction (IUGR) and to assess the agreement on the gestational age and the way of delivery in different clinical scenarios. Methods: A PubMed search was performed to identify all original articles on IUGR in the last 6 years. The most active 20 authors were selected as experts and were invited to respond to a survey on their preferred gestational age for elective delivery in several IUGR cases depending on Doppler measurements (including umbilical artery (UA), middle cerebral artery, cerebroplacental ratio, uterine artery and ductus venosus), biophysical profile and cardiotocography. Results: 15 of the 20 selected experts agreed to participate in the survey, of which 3 failed to meet the deadline to complete the survey. Management of IUGR was relatively uniform for abnormal UA, uterine artery or cerebroplacental ratio. Although average gestational age at delivery reflected a clear progression with accepted markers of severity, discrepancies of up to 4 weeks were found for abnormal middle cerebral artery Doppler and absent end-diastolic velocity in the UA, and of up to 8 weeks for reverse end-diastolic velocity in the UA and abnormalities in the ductus venosus Doppler. Conclusions: Management of IUGR is still far from being uniform among centers, with most controversy surrounding the management of early-onset IUGR. There is a need of prospective studies to address this issue.

Increased Umbilical Artery Pulsatility Index in Third-Trimester Fetuses with Trisomy 21

“…Regardless of the karyotype, the initial fetal Doppler abnormality in a third-trimester growth-restricted fetus is expected to occur in the MCA rather than the UA [21,22]. In our study, the MCA resistance was slightly lower than expected but was not below the 5th centile in any of our cases.…”

Clinical utility of third‐trimester uterine artery Doppler in the prediction of brain hemodynamic deterioration and adverse perinatal outcome in small‐for‐gestational‐age fetuses

“…UtA Doppler findings are recognized as relevant predictors of true fetal growth restriction and poor perinatal outcome among small fetuses 34,35 . However, its independent value in relation to brain Doppler has not been addressed previously.…”

ISUOG Practice Guidelines: diagnosis and management of small‐for‐gestational‐age fetus and fetal growth restriction

“…In pregnancies with late FGR and UA-PI above the 95 th percentile, expert opinion is that delivery should be considered when the gestation is beyond 36 + 0 weeks and not later than 37 + 6 weeks 105 .…”