Management of the growth-retarded fetus

In this paper techniques for monitoring the condition of the intra-uterine growth-retarded (IUGR) fetus are reviewed. Doppler measurements of umbilical artery velocity waveforms may be used to identify IUGR fetuses at risk of becoming hypoxaemic. With the use of antenatal fetal heart rate (FHR) monitoring the actual fetal condition can quite accurately be assessed. The timing of delivery of the IUGR fetus depends on many aspects. A proposal for the timing of delivery of these fetuses, based on three variables (gestational age, FHR pattern, Doppler) is presented. Such a proposal contains many uncertainties, as controlled trials in which early versus later delivery are compared, are lacking. Particularly at early gestation the obstetrician is confronted with the dilemma of delivering a fetus before signs of hypoxaemia occur, with a consequent risk of prematurity related neonatal problems, or leaving the fetus in utero longer in the hope of improving maturation, but then the impact of prolonged malnutrition on the brain may offset these benefits. Possibilities for in utero treatment of fetal growth retardation--briefly discussed in this paper--are limited. This implies that the impact of obstetrical management on perinatal morbidity will only be marginal.