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Antenatal assessment of the growth restricted fetus
1Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland, Baltimore 21201-1703, USA. aabaschat@hotmail.com
Insights
Intrauterine growth restriction (IUGR) in babies increases risks for poor outcomes. Monitoring fetal status with biometry, biophysical profile scoring, and Doppler assessments helps manage these high-risk pregnancies.
Area of Science:
- Perinatology
- Neonatology
- Fetal Medicine
Background:
- Intrauterine growth restriction (IUGR) is associated with adverse perinatal and long-term outcomes compared to appropriately grown infants.
- Deteriorating fetal status in IUGR can be identified through serial antenatal testing.
Purpose of the Study:
- To review the assessment of fetal compromise in intrauterine growth restriction.
- To examine an integrated management protocol for high-risk pregnancies complicated by IUGR.
Main Methods:
- Utilizing fetal biometry, biophysical profile scoring, and arterial/venous Doppler assessments to evaluate fetal well-being.
- Analyzing the interaction between fetal factors, gestational age, and neonatal course in preterm infants.
Main Results:
- The combination of fetal biometry, biophysical profile scoring, and Doppler accurately reflects fetal compromise and predicts risk of stillbirth or poor neonatal transition.
- Fetal factors, gestational age, and neonatal course significantly influence short- and long-term outcomes in preterm neonates.
Conclusions:
- Comprehensive antenatal assessment is crucial for managing intrauterine growth restriction and optimizing perinatal outcomes.
- An integrated management protocol considering fetal status and neonatal factors is essential for high-risk pregnancies, especially concerning iatrogenic prematurity.
Abstract:
Babies who are small due to intrauterine growth restriction are at higher risk for poor perinatal and long-term outcome than those who are appropriately grown. Through multiple antenatal testing modalities a sequence of deteriorating fetal status can be documented in such cases. The nature of this compromise is best reflected by the combination of fetal biometry, biophysical profile scoring and arterial and venous Doppler. This combination accurately defines fetal states and therefore risk of stillbirth or poor transition to extrauterine life. In the preterm neonate, fetal factors, gestational age and neonatal course interact significantly to impact on short- and long-term outcomes. The potential for iatrogenic prematurity is great and ongoing appraisal of peripartum management is critical. An integrated management protocol accounting for these factors is examined in this review.