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Obstetric management of the growth retarded baby
Insights
Managing intrauterine growth retardation requires early diagnosis and risk factor modification. Intensive prenatal surveillance and timely intervention are key for successful pregnancy outcomes in fetal growth restriction.
Area of Science:
- Obstetrics and Gynecology
- Fetal Medicine
- Perinatology
Background:
- Intrauterine growth retardation (IUGR) complicates pregnancies, necessitating careful management.
- Effective strategies involve risk factor identification, early diagnosis, and continuous monitoring.
Purpose of the Study:
- To outline the essential components for managing pregnancies affected by intrauterine growth retardation.
- To detail diagnostic evaluations and surveillance methods for fetal growth restriction.
Main Methods:
- Antepartum diagnosis via ultrasound and amniocentesis for karyotype and lung profile.
- Intensive fetal surveillance using non-stressed testing (NST) or contraction stress testing (CST).
- Serial sonography for amniotic fluid volume and fetal growth assessment; biophysical profile utilization.
Main Results:
- NST/CST testing aids in assuring fetal well-being and predicting perinatal morbidity.
- Serial oestriol values and sonography are important for monitoring fetal status.
- Optimal delivery timing is around 37-38 weeks, or earlier if fetal status deteriorates.
Conclusions:
- Successful management of IUGR hinges on early detection, risk factor modification, and intensive prenatal surveillance.
- Delivery decisions should be guided by fetal surveillance results, with Cesarean section often considered.
- Preparation for neonatal resuscitation is crucial at delivery for growth-restricted infants.
Abstract:
Identification and modification of potential risk factors, early diagnosis, intensive prenatal surveillance, and appropriate, timely intervention is necessary for successful management of the pregnancy complicated by intrauterine growth retardation. Once an antepartum diagnosis of fetal growth retardation has been made, extensive evaluation including a thorough ultrasound examination and amniocentesis (if technically possible) for fetal lung profile studies and karyotype is indicated. Intensive fetal surveillance with nonstressed testing (in the absence of oligohydramnios) or contraction stress testing on a weekly basis (if normal) can usually assure one of fetal well being. A combination of NST/CST testing may increase the effectiveness of predicting perinatal morbidity. Daily increasing serial oestriol urinary values may be of some benefit in assuring fetal well being. Serial sonography to assess amniotic fluid volume and interval fetal growth is important. Use of the biophysical profile may significantly improve the perinatal outcome, but substantiation in a large group of growth retarded infants is lacking. Delay of delivery until 37-38 weeks' gestational age (or, in the hypertensive patient, until fetal lung maturity is documented) currently appears optimal. However, in the face of fetal surveillance testing suggesting a deterioration in fetal status or lack of interval growth, delivery should be undertaken. The mode of delivery will depend rather on the indication for intervention. Caesarean section should be seriously considered in many cases of intrauterine growth retardation. At the time of delivery, the paediatric team should always be present and ready to resuscitate the infant if necessary and to anticipate potential problems associated with the growth retarded fetus.