Impaired fetal growth: ultrasonic evaluation and clinical management

Area of Science:

• Obstetrics and Gynecology
• Fetal Medicine
• Diagnostic Ultrasound

Background:

• Biparietal diameter (BPD) is a standard fetal biometric, but its accuracy in diagnosing intrauterine growth retardation (IUGR) is limited to 50% of cases.
• Intrauterine growth retardation (IUGR) poses significant risks to fetal well-being and requires accurate diagnostic methods.
• Current diagnostic methods for IUGR have limitations, necessitating improved approaches for early and reliable detection.

Purpose of the Study:

• To evaluate the diagnostic accuracy of serial abdominal circumference (AC) measurements for identifying impaired fetal growth.
• To assess the combined utility of biparietal diameter (BPD) and AC in estimating fetal weight for improved IUGR diagnosis.
• To explore the role of additional ultrasonic parameters (amniotic fluid volume, fetal tone, placental texture) in diagnosing IUGR.

Main Methods:

• Retrospective analysis of fetal biometric data, including BPD and AC, from ultrasound examinations.
• Comparison of diagnostic accuracy between BPD alone, serial AC measurements, and combined BPD-AC for fetal weight estimation.
• Inclusion of qualitative ultrasonic assessments of amniotic fluid, fetal tone, and placental texture in the diagnostic evaluation.

Main Results:

• Serial AC measurements demonstrate higher accuracy in identifying impaired fetal growth compared to BPD alone.
• Combined BPD and AC measurements improve the estimation of fetal weight, directly addressing the basis of IUGR diagnosis.
• Ultrasonic assessment of amniotic fluid, fetal tone, and placental texture provides supplementary value in diagnosing IUGR.

Conclusions:

• Serial AC assessment and combined BPD-AC measurements are superior to BPD alone for diagnosing fetal growth restriction.
• Ultrasonic evaluation of ancillary parameters aids in the comprehensive diagnosis of IUGR.
• Clinical management of IUGR involves addressing maternal factors, continuous monitoring, and timely delivery when fetal or maternal status deteriorates.