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Screening for intrauterine growth retardation in late pregnancy
Insights
Identifying intrauterine growth retardation (IUGR) risk factors is crucial for antenatal care. Early screening for smoking, low weight, and pre-eclampsia, combined with symphysis-fundus measurements, helps identify high-risk pregnancies for closer monitoring.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Maternal-Fetal Medicine
Background:
- Intrauterine growth retardation (IUGR) poses significant risks to newborns.
- Accurate antenatal diagnosis of IUGR is essential for timely intervention.
- Existing screening methods for IUGR require refinement for improved detection rates.
Purpose of the Study:
- To evaluate the effectiveness of simple clinical tests in diagnosing IUGR.
- To investigate risk factors for IUGR that manifest in late pregnancy.
- To identify high-risk pregnancies for enhanced monitoring during the last trimester.
Main Methods:
- Prospective study on an unselected population.
- Measurement of symphysis-fundus (SF) distance to monitor fetal growth.
- Recording of maternal pregnancy weight gain.
- Analysis of late-pregnancy risk factors: vaginal bleeding, pregnancy hypertension, and pre-eclampsia.
- Retrospective identification of infants with severe IUGR.
Main Results:
- A pathological SF curve, observed in 3.5% of cases, served as a valuable screening tool for IUGR.
- Pre-eclampsia was the sole late-pregnancy risk factor significantly associated with IUGR.
- Combining early screening factors (smoking, previous low birth weight infant, low pre-pregnancy weight, renal disease, addiction) with pre-eclampsia screening identified 22% of the population as high-risk.
- 23 out of 27 infants with severe IUGR were born to mothers with identified high-risk factors or a pathological SF curve.
Conclusions:
- Simple clinical tests, particularly symphysis-fundus measurements, are valuable for screening IUGR.
- Pre-eclampsia is a key late-pregnancy risk factor for IUGR.
- A comprehensive screening approach, including early and late-pregnancy factors, effectively identifies high-risk pregnancies for targeted monitoring and improved perinatal outcomes.
Abstract:
A prospective study was performed on an unselected area-based population in order to improve the antenatal diagnosis of intrauterine growth retardation (IUGR). The clinical importance of simple clinical tests to follow fetal growth (measurements of the symphysis-fundus (SF) distance and recordings of maternal pregnancy weight gain) was investigated. Risk factors for IUGR, appearing in late pregnancy (vaginal bleeding, non-proteinuric pregnancy hypertension and pre-eclampsia) were also studied. A pathological SF curve (frequency 3.5%) was found to be valuable, but mainly as a screening instrument rather than a diagnostic tool for IUGR. Pre-eclampsia was the only risk factor appearing in late pregnancy that could be associated with IUGR. Previously we have recommended early pregnancy screening for the following high risk factors for IUGR: smoking, previous birth of a low birth weight infant, low pre-pregnancy weight, renal disease and addiction. When also screening for pre-eclampsia, 22% of the population exhibited at least one screening factor. Retrospectively we identified all severely growth-retarded infants (birth weight for gestational age less than or equal to -2 S.D.) born in 1980 (n = 27). 23 of these infants were delivered to mothers exhibiting high-risk factors for IUGR or a pathological SF curve. In this way a high-risk group for IUGR can be identified, which should be monitored more carefully during the last period of pregnancy.