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Intrauterine growth retardation
Insights
Fetal growth retardation is a major cause of perinatal death. Antenatal monitoring helps reduce stillbirths and improve infant survival, with most growth-restricted infants having a satisfactory prognosis.
Area of Science:
- Perinatal Medicine
- Fetal Monitoring
- Obstetrics
Background:
- Fetal growth retardation is a significant contributor to perinatal mortality.
- Antenatal fetal monitoring is crucial for reducing stillbirths and improving outcomes for live-born infants.
Purpose of the Study:
- To highlight the importance of identifying fetuses at risk of hypoxia, regardless of growth status.
- To compare biochemical and ultrasonographic testing methods for antenatal fetal assessment.
Main Methods:
- Utilizes antenatal fetal monitoring, including biochemical testing of fetoplacental function and cardiotocography.
- Combines clinical assessment with biochemical and ultrasonographic testing to identify growth-retarded fetuses.
Main Results:
- Current methods identify up to 70% of growth-retarded fetuses.
- Not all small-for-dates fetuses are at risk, and some fetuses at risk are not growth-retarded.
- The prognosis for growth-retarded infants managed with current methods is generally satisfactory.
Conclusions:
- Identifying fetuses at risk of hypoxia is paramount in obstetric care.
- Biochemical and ultrasonographic tests have different aims and are not directly comparable.
- With appropriate antenatal management and delivery timing, most growth-retarded infants have positive physical and intellectual outcomes.
Abstract:
Fetal growth retardation ranks third after prematurity and malformations as a cause of perinatal deaths. Antenatal fetal monitoring (biochemical testing of fetoplacental function plus cardiotocography) has emerged as the most important means of reduction in the number of stillbirths and improvement in the quality of survival of infants who are born alive. Clinical acumen combined with biochemical and/or ultrasonographic testing will identify no more than 70% of growth retarded fetuses. However, not all small for dates fetuses are at risk, and many doomed to die in utero are not by definition, growth retarded. It should be the obstetrician's aim to identify the fetus at risk of death from hypoxia whether growth retarded or not. Biochemical and ultrasonographic methods of testing are not truly comparable, since some aim to identify the growth retarded fetus, irrespective of his state of health, whereas others aim to detect fetoplacental dysfunction, irrespective of whether or not the fetus is growth retarded. With present methods of antenatal diagnosis and treatment and timing of delivery determined by nonstressed cardiotocography, the physical and intellectual prognosis of growth retarded infants is most satisfactory; follow-up studies have shown that only about 2% of these infants are severely handicapped.