10 - Obstetric Management of the Growth Retarded Baby

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.