Intrauterine growth restriction

Intrauterine growth restriction remains one of the major problems in obstetrics. Recent published literature on this problem is summarized in this review.

Intrauterine growth restriction contributes disproportionately to neonatal mortality and morbidity in both preterm and term babies, and is a predisposing factor to major psychiatric sequelae such as depression, suicide and suicidal attempts. More evidence is accumulating to show that fetal Doppler changes of the ductus venosus and umbilical vein are good surrogate markers for fetal academia. The timing of delivery remains controversial, however. The Growth Restriction Intervention Trial showed that delayed delivery in those up to 30 weeks may be associated with lower rates of cerebral palsy and Griffiths development quotient under 70. In dichorionic twins, selective fetocide of one severe intrauterine growth restriction fetus in midtrimester twin pregnancies complicated by severe preeclampsia may abort the disease process and prolong the pregnancy. For monochorionic twins, the finding of intermittent absent or reversed end diastolic flow in the umbilical artery may be a manifestation of the transmission of the bi-directional waveforms of arterio-arterial anastomosis, but has been shown to be associated with an increased risk of intrauterine death in the growth restricted fetus and brain damage in the larger fetus.

The timing of delivery of the preterm growth restricted fetus remains controversial. Intrauterine growth restriction with intermittent absent or reversed end diastolic flow in the umbilical artery of monochorionic twins poses difficulties in assessment.