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Published on: June 29, 2013
Intrauterine growth restriction: screening, diagnosis, and management
Andrea Lausman1, John Kingdom1,
1Toronto ON.
Insights
Identifying pathological intrauterine growth restriction (IUGR) is crucial for timely intervention. This guideline offers a framework for screening, diagnosis, and management of IUGR pregnancies to improve outcomes.
Area of Science:
- Obstetrics and Gynecology
- Perinatology
- Fetal Medicine
Background:
- Intrauterine growth restriction (IUGR) affects approximately 10% of fetuses.
- Distinguishing pathological IUGR from constitutional smallness is essential for effective intervention.
- Early identification of IUGR can decrease associated morbidity and mortality.
Purpose of the Study:
- To provide evidence-based summary statements and recommendations for IUGR.
- To establish a comprehensive framework for screening, diagnosis, and management of IUGR.
- To guide clinicians in managing pregnancies complicated by fetal growth restriction.
Main Methods:
- Systematic review of published literature (PubMed, MEDLINE, CINAHL, Cochrane Library) up to January 2013.
- Inclusion of systematic reviews, RCTs, CCTs, and observational studies.
- Inclusion of grey literature from health agencies, guideline collections, and registries.
Main Results:
- Recommendations aim to improve clinician recognition of IUGR.
- Guidance provided for appropriate intervention in affected pregnancies.
- Emphasis on optimal long-term follow-up for neonates diagnosed with IUGR.
Conclusions:
- Implementation of these recommendations can enhance IUGR detection and management.
- Improved management strategies for IUGR are proposed.
- Focus on long-term infant health following IUGR diagnosis.
Background:
Intrauterine growth restriction (IUGR) is an obstetrical complication, which by definition would screen in 10% of fetuses in the general population. The challenge is to identify the subset of pregnancies affected with pathological growth restriction in order to allow intervention that would decrease morbidity and mortality.
Objective:
The purpose of this guideline is to provide summary statements and recommendations and to establish a framework for screening, diagnosis, and management of pregnancies affected with IUGR.
Methods:
Affected pregnancies are compared with pregnancies in which the fetus is at an appropriate weight for its gestational age. History, physical examination, and laboratory investigations including biochemical markers and ultrasound characteristics of IUGR are reviewed, and a management strategy is suggested.
Evidence:
Published literature in English was retrieved through searches of PubMed or MEDLINE, CINAHL, and The Cochrane Library in January 2013 using appropriate controlled vocabulary via MeSH terms (fetal growth restriction and small for gestational age) and key words (fetal growth, restriction, growth retardation, IUGR, low birth weight, small for gestational age). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.
Values:
The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table).
Benefits, Harms, And Costs:
Implementation of the recommendations in this guideline should increase clinician recognition of IUGR and guide intervention where appropriate. Optimal long-term follow-up of neonates diagnosed as IUGR may improve their long-term health.
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