Ultrasound and biochemical findings in intrauterine growth retardation

An attempt was made to make an early diagnosis of intrauterine growth retardation due to chronic placental insufficiency using ultrasound cephalometry and biochemical tests of placental function. We examined 83 hospitalised patients in whom there was a risk or suspicion of chronic placental insufficiency. For each patient an average of 4 determinations were made of head diameter, 10 of estriol and 3 of pregnandiol urinary excretion, 6 serum HPL and 7 of heat stable alkaline phosphatase (HSAP). Fetal growth retardation was assumed if the last 2 determined head diameters were below the normal curve with the same tendency and with term being well predicted. Biochemical parameters were considered to indicate pathological changes if they were 95% below normal values, with 2 below this range or 3 continuously falling below the normal level. Infants were assessed after birth both neurologically and somatically according to DUBOWITZ. Small for date infants were those whose birth weight was below the 10th percentile (LUBCHENKO). This was found to be the case in 15 out of 83 newborns five of whom were younger than 37 weeks. These 15 could be diagnosed before birth with various degrees of certainty. For estriol and HPL this was 67% or 53% and these two parameters were found to be the most valuable. Cephalometry was found to be less valuable with 20%, pregnandiol levels with 9% and placental HSAP with 33%. Hence it is recommended to perform serial determinations of estriol and HPL in the third trimester of pregnancy in all patients with histories indicative of fetal growth retardation and in those in whom the uterus appears small for date.