Diagnose der intrauterinen Wachstumsretardierung - Vergleich von Klinik, Gesamtöstrogenbestimmung aus dem 24-h-Urin und Ultraschallbiometrie (Distanzmessungen, biparietaler Kopfdurchmesser und thorako-abdominaler Querdurchmesser) unter Berücksichtigung des antepartalen und subpartalen CTGs*

Abstract

This article presents the results of clinical examination, total oestrogen determination from 24-h urine and ultrasound biometry -- measurement of the biparietal head diameter and the thoraco-abdominal transverse diameter (under routine conditions) -- for diagnosing intrauterine growth retardation (IUGR). In addition, the antepartal and subpartal CTG's are evaluated in cases of foetal retardation of growth "Single determinations" are confronted with so-called "serial examinations (= observation of the course)". Repeated clinical examinations and multiple determinations of the total oestrogen elimination with the 24-h urine did not result in any clear improvement of the detection rates of deficient development of the foetus (discovery rate with clinical examination = 54%, total oestrogen determination = 60%); there was, in fact, a relatively high rate of false-positive diagnosis (false-positive diagnoses on clinical examination = 31%). On the other hand, simple ultrasound biometry (distance measurements) led to the discovery of about 78% of all foetal growth retardations (perc. less than 10), the false-positive diagnoses rate being only 9%. Pathological antepartal CTG's (less than 8 points according to the Meyer-Menck score) were seen in about 27% of the cases with growth retardation -- with, however, an approximately equal rate of pathological CTG's in newborn of "normal weight". The discovery rate of deficient development of the foetus has been increased by combining ultrasound biometry with the total oestrogen determination from the 24-h urine, to 88% (perc. less than 10). The same applies to the combination of ultrasound biometry with the clinical examination (rate of detection: 87%). Up to 77% of all cases with IUGR have been discovered both by combining the clinical examination with the total oestrogen determination or antepartal CTG, as well as by combining total oestrogen determination with antepartal CTG.