Early Onset Intrauterine Growth Restriction-Data from a Tertiary Care Center in a Middle-Income Country

Area of Science:

• Perinatology
• Maternal-Fetal Medicine
• Neonatology

Background:

• Early-onset intrauterine growth restriction (IUGR) before 32 weeks gestation presents unique clinical challenges.
• Isolated IUGR, without structural or genetic anomalies, requires specific management strategies.
• Understanding the incidence and outcomes of early IUGR is crucial for optimizing care.

Purpose of the Study:

• To describe clinical and ultrasound features of early-onset IUGR requiring delivery before 32 weeks.
• To determine the incidence of this condition within a specific hospital population.
• To analyze the relationship between gestational age at delivery and neonatal outcomes.

Main Methods:

• Prospective cohort study including 36 pregnancies with suspected or diagnosed early IUGR.
• IUGR suspicion defined by sonographic fetal weight estimation < p10 using Hadlock 4 technique before 32 weeks.
• Subanalysis based on gestational age at iatrogenic delivery (27-29 weeks vs. 30-32 weeks).

Main Results:

• Incidence of early IUGR was 1.98%, with 8.3% intrauterine fetal death rate.
• Severe cases (very early diagnosis/delivery) showed higher prenatal visit frequency and third-trimester uterine artery pulsatility index (UtA PI) centiles.
• Newborns in the very early IUGR subgroup required significantly more NICU and total hospitalization days.

Conclusions:

• Isolated early-onset IUGR before 32 weeks necessitates intensified prenatal and postnatal surveillance.
• Gestational age at birth and UtA PI centiles correlate with severity and resource utilization.
• These patients represent a significant healthcare economic burden due to prolonged hospitalizations.