Diagnosis Of Intrauterine Growth Retardation Research Articles

Prevalence of Intrauterine Growth Retardation on Antenatal Ultrasound Scan in Lahore, Pakistan

Fetal growth retardation is described as infants whose weights are much less than expected. Population based norms are used to categorize abnormal growths. The objective of the study was to determine the frequency of intrauterine growth retardation on antenatal ultrasound scan. It was an observational descriptive study conducted at the Radiology Department of Fatima Memorial Hospital, Shadman Lahore. Patients visited the Ultrasound Department for Obstetric scan. The study was conducted in 6 months from January to June in 2022. The sample size of 87 was calculated for study with expected rate of 9% of pregnancies resulted in intrauterine growth retardation at 5% level of significance at 5% margin of error. The study included pregnant females in third trimesters of pregnancy. The data was analyzed using SPSS version 20. A total of 87 obstetric ultrasounds were performed during the study period. The mean age of the patients was 28.69 ±4.46 years with age range 20-42. The 87 included patients showed mean gestational age 35.29 ±2.50 weeks. The mean biparietal diameter was 8.69±0.57 cm and abdominal circumference was 29.72±3.03 cm. The mean fetal body weight is 2.52±0.59 kg. The frequency of intrauterine growth retardation was 10.3%. Fetal biometry, biophysical profile and Doppler studies were helpful in the diagnosis of intrauterine growth retardation and evaluation of ultrasound parameters in third trimester.

“ROLE OF FETAL MRI IN EVALUATION OF CONGENITAL ANOMALIES”

When US evaluation of the second and third-trimester foetus is limited, MR imaging might be used as a supplemental test. Due to a lack of an acceptable acoustic window, US is often limited in cases of oligohydramnios or breech presentation. In both cases, however, MR imaging can clearly show the foetal anatomy in detail. Ossification of the calvaria[1], which inhibits view of the posterior fossa at US, can also impede third trimester foetal assessment. US frequently suggests intracranial pathologic abnormalities such as posterior fossa anomalies (Chiari II syndrome, cerebellar aplasia or hypoplasia). MR imaging can corroborate the US findings, and it can also provide a diagnosis in some circumstances, such as neuronal migrational anomalies. MR imaging certainly has the advantage of being able to analyse the foetus in many planes within a greater field of view. T1-weighted MR imaging can show acute and chronic germinal matrix bleeding, as well as ischemia alterations. Although ultrasound is helpful in detecting corpus callosum abnormalities, it can miss many of the central nervous system problems associated with corpus callosum agenesis. Because the prognosis of agenesis of the corpus callosum is so unpredictable, detecting concomitant central system defects on MR imaging can help with prenatal and postnatal medical care. Although the majority of prenatal MR imaging applications are related to the cranial nervous system, new developments in foetal surgical intervention have expanded the utility of foetal MR imaging in thoracoabdominal illness detection. Fetal MR imaging can help diagnose abnormalities such congenital cystic adenomatoid malformation, congenital diaphragmatic hernia, cystic hygroma, and bronchopulmonary sequestration. Accurate assessment of foetal lung and liver sizes is critical in foetal surgical planning and postnatal prognosis in the case of congenital diaphragmatic hernia. Some high-risk pregnancies may also benefit from obstetric MR imaging, according to preliminary research. With a combination of foetal weight estimates and liver volume measurements, birth weight may be correctly predicted and the diagnosis of intrauterine growth retardation or macrosomia can be made with confidence.

Correlation between Gestational Age and Abdominal Circumference in Second Trimester

Gestational age is age of unborn baby, defined in weeks as beginning from first day of last menstrual periodprior to conception. Estimation of gestational age and thereby forecasting Expected Date of Delivery is notonly concern of the Individual but it is invaluable in the diagnosis of intrauterine growth retardation of fetusand obstetric planning. Determination of age of a fetus by using various methods is required for medico legalpurposes in both civil and criminal matters. In present study we assesses Correlation between gestationalage and abdominal circumference in second trimester, The study of Correlation between gestational ageand abdominal circumference in second trimester by Ultrasonography was carried out and collected datawas tabulated according to weeks of menstrual cycle and were taken in centimeters. Standard deviationof abdominal circumference for each week was calculated. We found that Abdominal Circumference isstatistically highly significant and the regression equations derived for growth parameter for estimatinggestational age in a normally developing fetus, increase with gestational age, showed good correlation withgestational age.

Erken ve geç başlangıçlı intrauterin gelişme geriliğinin perinatal sonuçları

Amaç: Bu çalışmanın amacı erken ve geç başlangıçlı İntrauterin gelişme geriliği (İUGG) perinatal sonuçlara etkisini ve aradaki farkları gösterilmesidir. Gereç ve Yöntem: Çalışmamız retrospektif bir çalışmadır. Çalışmamızda 01 Ocak 2015- 01 Ocak 2019 tarihleri arasında İUGG tanısıyla takibe 334 hasta erken ve geç başlangıçlı IUGG olmak üzere alt gruplara ayrıldı. Gelişme geriliği tipi, tanı aldığı gebelik haftası, tahmini fetal ağırlığı (TFA), preeklampsi varlığı, Doppler bulguları, doğum kilosu, doğum şekli, doğum haftası, 5.dk Apgar skoru, yenidoğan yoğun bakım ihtiyacı kayıt edildi ve tüm bu parametrelerin yenidoğanın olumsuz sonuçlarıyla ilişkisi ele alındı. Bulgular: Tanı konulan gebelik haftası ortalaması 30,9±4,5 (min-maks:18-39)’dır. Hastaların doğum haftası ortalaması 34,4±4,5 (min-maks:22-41)’dır. Hastalar tanı aldıkları gebelik haftasına göre <27+6, 28-31, 32-36, >37 hafta olarak dört grupta incelendi. Verilerimiz doppler bulgularının şiddeti ile perinatal sonuçların kötüleştiğini ortaya koymaktadır. Yine çalışmamız TFA<%3 persentil olmasının ve erken başlangıçlı IUGG olmasının fetüslerin perinatal sonuçlarını olumsuz etkilediğini gösterdi. Sonuç: Geç başlangıçlı preeklampsi IUGG’li bebeklerin perinatal sonuçlarını olumsuz etkilememektedir fakat erken başlangıçlı preeklampsi yenidoğan morbidite ve mortalitesindeki artışa neden olmaktadır. Bu sebeple erken başlangıçlı preeklampsinin eşlik ettiği erken başlangıçlı IUGG’li hastalar daha yakından takip edilmeli ve perinatal morbidite ve mortalite için uyanık olunmalıdır.

Correlation between Gestational Age and Head Circumference in Third Trimester

Introduction: In today’s advanced medical world maternal child health care the important part of the healthcare system and import components is estimation fetal gestational age.Gestational age is age of unborn baby, defined in weeks as beginning from first day of last menstrualperiod prior to conception. Trimester is period of three calendar months during a pregnancy. Clinically, thegestational period is divided into three trimesters. Estimation of gestational age and thereby forecastingexpected date of delivery (EDD) is not only concern of the Individual but it is invaluable in the diagnosis ofintrauterine growth retardation of fetus and obstetric planning other fetal parameters are useful Hence; weplanned the present study to estimate fetal HC length for measuring the gestational age and compare it withother parameters.Material and methods: The study Correlation between gestational age and head circumference in Thirdtrimester was carried out at Govt. Medical College and Hospital, Nanded, between July 2011 to July 2013period . The study included 132 pregnant women the data so collected was then subjected to statisticalanalysis by expert statistician with the help of SYSTAT Crainsoft version 12 software. Standard statisticalmethods, parametric methods were used for the evaluation and significance.Results: As the value of R is 0.8612, the variation in fetal growth on the basis of Head Circumference duringthird trimester can be explained to the extent of 86.12%. The value of R is highly significant (Student’s‘t’test value = 228.92, p<0.0001, very highly significant) showing that there is statistically highly Positive orstrong positive association between gestational age and head CircumferenceConclusion: From the present study Head Circumference found to be statistically highly significant. Theregression equations derived for growth parameter for estimating gestational age in a normally developingfetus, increase with gestational age, showed good correlation with gestational age. In Present study, Headcircumference is the sensitive parameter and a result of present study was comparable with previous studies.

Evaluation of first-trimester neutrophil-lymphocyte ratio and platelet-lymphocyte ratio values in pregnancies complicated by intrauterine growth retardation.

Objective:The objective of this study is to compare the first-trimester hemogram parameters [neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR)] of pregnant women complicated by intrauterine growth retardation (IUGR) and normal pregnant women.Materials and Methods:We retrospectively evaluated the medical records of pregnant women (n=50) complicated with IUGR and pregnant women in the control group (n=50).Results:The first-trimester NLR and PLR values of the pregnant women complicated by IUGR were 6.59±1.12 and 117.2±16.00, respectively. The first-trimester NLR and PLR values of the pregnant women in the control group were 2.84±0.55 and 112.80±13.01, respectively. There was a statistically significant difference between the two groups with respect to NLR (p<0.001).Conclusion:Pregnancies complicated by IUGR have high neonatal mortality and morbidity rates. Therefore, the early diagnosis of disease and appropriate management are extremely crucial for both fetal and maternal prognoses. High NLR values in the first trimester may contribute to the early diagnosis of IUGR.

Accuracy of Transverse Cerebellar Diameter measurement by Ultrasonography in the evaluation of fetal age

Background: Perinatal mortality a concern in the developing countries and intrauterine growth restriction (IUGR) is an important cause. Therefore early diagnosis of IUGR babies is the key to prevent complications as well as mortality. Multiple biometric parameters including trans-cerebellar diameter can be used to predict the gestational age. Thus, the present study was designed to measure and compare the trans-cerebellar diameter and evaluates the usefulness of transverse cerebellar diameter as against the conventional parameters and to find out the usefulness of transverse cerebellar diameter in antenatal diagnosis of intrauterine growth retardation. Methods: A cross-sectional study was conducted on normal antenatal women of 15-40 weeks gestational age referred for antenatal ultrasonography between January to December 2015. Total 250 patients were examined. Data collected was compared with the conventional parameters. Results: Good correlation was found between transverse cerebellar diameter (TCD) and other parameters. Also TCD showed a linear relationship between the cerebellar growth and the gestational age. It was found to be better than BPD in circumstances like excessive molding and dolicocephaly. Also TCD measurement was not fraught with problems as encountered in FL measurement. The mean TCD/AC ratio was 13.866%. So it was found that TCD can be used as a reliable parameter for determination of gestational age in mass studies. Conclusion: There is good correlation between TCD and other parameters in normal pregnancies at 15 to 40 weeks of gestation. This implies that, TCD is a better parameter for gestational age assessment compared to BPD and FL.

Color Doppler Imaging of Cerebral-Umbilical Pulsatility Ratio in Intrauterine Growth Retardation

Background: Intrauterine growth retardation (IUGR) refers to a condition in which a fetus is unable to achieve its genetically determined potential size. IUGR may also be defined as growth at the 10th or less percentile for weight of the all fetuses at that gestational age. It has long been recognized that impaired fetoplacental perfusion is associated with intrauterine growth retardation. Ultrasonography with Color Doppler has provided a new tool for this purpose.Objective: To evaluate the role of Color Doppler ultrasonography in the diagnosis of IUGR.Materials and Methods: This prospective study was carried out in the department of Radiology &amp; Imaging of Dhaka Medical College Hospital within a period of January 2010 to September 2011 on 90 patients aged between 17?35 years who were clinically suspected as cases of IUGR or previously USG diagnosed cases of IUGR.Results: The highest incidence of IUGR was found in the age group between 21?25 years. The mean gestational age at birth was 33.2 ± 3.5 weeks and mean birth weight 1.3 ± 6.2 kg in case of abnormal cerebral-umbilical (C/U) ratio group. According to cerebral-umbilical pulsatility index (PI) value 65 cases (72.2%) were diagnosed as abnormal and 25 (27.8%) as normal flow pattern. Perinatal findings showed that 67 were small for gestational age (SGA) and 23 had normal birth weight. The validity of cerebral-umbilical PI ratio for diagnosis of IUGR was studied by calculating sensitivity, specificity, accuracy, PPV and NPV.Conclusion: In this study Color Doppler findings of cerebral-umbilical vessels and the validity tests reveal that Color Doppler evaluation of middle cerebral artery (MCA) and umbilical artery (UA) PI ratio is an useful modality in diagnosis of IUGR.J Enam Med Col 2017; 7(3): 140-145

Color Doppler Evaluation of Cerebral - Umbilical Pulsatility Ratio and its Usefulness in the Diagnosis of Intrauterine Growth Retardation and Prediction of Adverse Perinatal Outcome

The purpose of this study is Evaluation of cerebral umbilical pulsatility ratio by color Doppler and to estimate the value of pulsatility index ratio of cerebral umbilical vessels in the diagnosis of small-for-gestational-age (SGA) fetuses and in the prediction of adverse perinatal outcome . Validity of the test were confirmed by determining sensitivity, specificity, accuracy, positive predictive value, negative predictive value. The study population comprised 40 pregnancies of 30-41 weeks gestation that had been diagnosed clinically as intrauterine growth retardation (IUGR) over a period of 1 year. The cerebral - umbilical pulsatility ratio (C/U ratio) were calculated. The pregnancies were followed up and the final perinatal outcome of each case were noted. Various intraparum and neonatal indicators were used to assess the outcome, with an adverse outcome being defined as the presence of one or more of these indicators. The most common adverse perinatal outcome was birth asphyxia, low apgar score, stay at NICU, still birth and caesarean section for fetal distress. Of the 40 pregnancies in the study, 30 (75%) showed abnormal C/U ratio. Among these, 32 (80%) were SGA and 32 (80%) had adverse perinatal outcome. Of the 30 out of 40 pregnancies that showed abnormal C/U ratio (&lt;1.08), all 30 (80%) were SGA and had adverse perinatal outcome. The results were correlated with parameters of fetal outcome. Inferences drawn from the study was that C/U ratio is a tools for prediction of SGA fetuses and adverse perinatal outcome.J Bangladesh Coll Phys Surg 2016; 34(3): 145-150

The correlation between serum levels of soluble platelet -selectin in preeclampsia with &amp; without intrauterine growth retardation versus normal pregnancy

Background: preeclampsia is characterized by endothelial dysfunction with vasoconstriction due to cell adhesion molecules or mediators released by defective placentation. Soluble platelet selectin, one of the cell adhesion molecules, is elevated in many inflammatory conditions including preeclampsia.Objective: To investigate if soluble platelet-selectin levels can be used as a marker for adverse outcomes in pregnancy complicated with sever preeclampsiaPatients and methods:This study involved 115 pregnant women in their third trimester of pregnancy; divided into Group A: involves 25 pregnant women with preeclampsia complicated by intrauterine growth restriction.Group B: involves 35 pregnant women with preeclampsia without intrauterine growth restriction.Control group: involve 55 pregnant women with normal blood pressure and normal fetal growth .The data were conducted from patients by special questionnaire, this involve name, age, parity, examination included vital signs, abdominal, obstetrical examination and investigations including :Liver function test, Renal function test, Complete blood picture and maternal serum levels of soluble platelet selectin was measured by enzyme-linked immunosorbent assay ,albumin in urine and serial obstetrical ultrasound scan to confirm the diagnosis of intrauterine growth retardation and Doppler study to determine fetuses at risk .Results: this study revealed a significantly higher concentration of soluble platelet selectin levels in serumofpreeclamptic women with and without intrauterine growth retardation versus normotensive and normal fetal growth. The maternal serum levels of sP-selectin in preeclampsia without intrauterine growth restriction were significantly higher than preeclampsia complicated by intrauterine growth restriction .Sensitivity was 91.7% and specificity 100% at cut off value 6.975 ng/ml of maternal soluble platelet _selectin for prediction of adverse pregnancy outcome .Conclusion: soluble platelet -selectin levels have a positive significant correlation with the severity of preeclampsia, so it can beconsidered as a marker for its severity and can be used as a predictor for adverse outcomes as itsnegatively correlated with these complications

Role of Colour Doppler Indices in the Diagnosis of Intrauterine Growth Retardation in High-Risk Pregnancies

Intra uterine growth retardation (IUGR) due to fetoplacental vascular insufficiency is rampant in developing countries like India. Owing to the lack of awareness, antenatal patients often present in their third trimester for their first ultrasound examination. Alterations in the waveforms and Doppler indices of fetal middle cerebral artery (MCA), umbilical artery and bilateral uterine arteries have been extensively described in various studies in the literature. However, the role of each doppler parameter in actually predicting reduced birth weight (for gestational age) in the third trimester is often debatable and frustrating. A prospective study was done on 100 patients of clinically suspected IUGR/high-risk pregnancies of 31-41weeks. The cases were followed till delivery; the doppler and grey scale findings were correlated with the birth weight of the baby. The highest sensitivity was found to be of HC/AC ratio, (84.4%), the highest specificity of oligohydramnios and Cerebral/Umbilical Pulsatility ratio[C/U ratio] (100%). The sensitivity of C/U ratio was found to be 68.8%. Fetal MCA had the lowest sensitivity (7.7%). HC/AC ratio is quite sensitive, and oligohydramnios is a highly specific parameter to diagnose IUGR. However, the former has lower specificity, and the latter has very poor sensitivity. The MCA PI alone is not sensitive at all, and should not be used for screening purposes in IUGR patients. Also, C/U ratio is more sensitive than oligohydramnios and more specific than HC/AC ratio and stands out as the best parameter of all to diagnose IUGR in the third trimester.

Color doppler evaluation of cerebral-umbilical pulsatility ratio and its usefulness in the diagnosis of intrauterine growth retardation and prediction of adverse perinatal outcome

Objective:The aim of our study was to evaluate the usefulness of the pulsatility index (PI) of the umbilical artery (UA) and that of the fetal middle cerebral artery (MCA), as well as the ratio of the MCA PI to the UA PI (C/U ratio), in the diagnosis of small-for-gestational-age (SGA) fetuses and in the prediction of adverse perinatal outcome.Materials and Methods:The study population comprised 90 pregnancies of 30-41 weeks gestation that had been diagnosed clinically as intrauterine growth retardation (IUGR) over a period of 1 year. The UA PI and the MCA PI as well as the C/U ratio were calculated.Results:Of the 90 pregnancies in the study, 24 showed abnormal UA PI. Among these, 21 (87.5%) were SGA and 19 (79.2%) had adverse perinatal outcome. Of the four of the 90 pregnancies that showed abnormal MCA PI, all were SGA and had adverse perinatal outcome. Similarly, of the 20 out of 90 pregnancies that showed abnormal C/U ratio (<1.08), all 20 (100%) were SGA and had adverse perinatal outcome. The results were correlated with parameters of fetal outcome.Conclusion:Inferences drawn from the study were: (1) The C/U ratio is a better predictor of SGA fetuses and adverse perinatal outcome than the MCA PI or the UA PI used alone, (2) The UA PI can be used to identify IUGR per se and (3) The MCA PI alone is not a reliable indicator for predicting fetal distress.

What is the contribution of Doppler sonography of the umbilical artery in diagnosis of intrauterine growth retardation?

Pulsed Dopplersonography of the umbilical artery was performed in 155 singleton high-risk pregnancies without malformations or chromosomal abnormalities. 59 foetuses were classified as foetuses with intrauterine growth retardation (IUGR). 46 of them had a birth weight below the tenth percentile. In 20 cases the pulsatility index (PI) was elevated (sensitivity: 44%). In all there were 50 neonates with a birth weight below the tenth percentile, 46 of whom were detected by biometry (sensitivity: 92%). 8 dystrophic neonates with a biometry that revealed IUGR were compromised by perinatal asphyxia. In six cases operative delivery was necessary and two cases with reversed diastolic flow ended in intrauterine foetal death. 7 of those foetuses had an elevated PI. The sensitivity of Dopplersonography in this group was 88%, the negative predictive value 97%. The positive predictive value with regard to a dystrophic neonate can be improved from 78% to 91%, if compared with biometry alone. Summing up, Dopplersonography of the umbilical artery can distinguish very well between IUGR foetuses at risk of perinatal morbidity or mortality and those IUGR foetuses with sufficient placental circulation who are, therefore, not at risk.

The use of biochemical markers in prenatal diagnosis of intrauterine growth retardation: insulin-like growth factor I, Leptin, and alpha-fetoprotein

Objective: To determine the relation between weight deficit at birth and IGF-I, IGFBP-I, Leptin, and AFP levels in amniotic fluid after 14–18 weeks; to assess the diagnostic usefulness of these biochemical markers. Study design: Longitudinal, prospective study. Amniocentesis was performed in pregnant women after 14–18 weeks of gestation. Study population: 86 controls, 18 IUGR <10 percentile, and 17 IUGR <5 percentile. Results: No significant correlation was found between severity of IUGR and IGF-I, IGFBP-I, or Leptin. AFP was inversely correlated with severity of IUGR; results for the IUGR <10 percentile were: S: 65.7%, SP: 56.9%, PPV: 38.3%, NPV: 80.3%, and an overall diagnostic capacity of 65.6%. Results for the IUGR <5 percentile were: S: 76.4%, SP: 54.8%, PPV: 21.6%, NPV: 93.4% were obtained, and an overall capacity of 70.6%. Conclusions: Elevated values of AFP in amniotic fluid may help early detection of populations at risk of developing IUGR.

Neonatal management of the growth-restricted infant

Close collaboration between obstetricians and neonatologists is essential for proper care of the growth-restricted fetus. A joint decision on the appropriate timing of delivery is made, based on the risk of fetal compromise compared with that of neonatal morbidity. A neonatal resuscitative team should be available at delivery. Gestational assessment, anthropological measurements and physical examination are necessary to confirm the diagnosis of intra-uterine growth retardation and establish the symmetric, asymmetric, combined or dysmorphic classification. Neonatal management requires special attention to a number of significant morbidities that growth-restricted infants are more prone to develop compared with normally grown infants, including asphyxia, meconium aspiration syndrome, respiratory distress syndrome, massive pulmonary haemorrhage, chronic lung disease, hypothermia, hypoglycaemia, hypocalcaemia, polycythaemia–hyperviscosity, intraventricular haemorrhage, sepsis, necrotizing enterocolitis, coagulation abnormalities, and congenital anatomical and genetic abnormalities. Intra-uterine growth retardation is associated with a higher stillbirth rate and infant mortality rate in preterm, term and post-term infants.

Índice ponderal para calificar a una población de recién nacidos a término

The terms small, appropriate, and large for gestational age cannot identify some alterations in body composition that might be identified by the ponderal index. The aim of the present study was to correlate birth weight with ponderal index to identify other patterns of intrauterine growth. We performed a cross-sectional, descriptive study in which only one curve of the ponderal index was created for each week of gestational age (weeks 33 to 42) and including the 10th, 50th and 90th centiles because sex does not influence this index. This curve was based on 26,770 healthy infants born in Uruguay and registered in the Perinatal Information System of the Latin American Center for Perinatology. The database consisted of 194,908 infants born between 1995 and 1999. Exclusion criteria were mothers aged less than 15 years or more than 35 years, primiparas, those with > 4 pregnancies, smokers, a diagnosis of intrauterine growth retardation, chronic and pregnancy-related hypertension, cardiac problems, anemic and diabetic mothers, twins with congenital malformations, and intervals between pregnancies of less than 2 years or more than 5 years. Finally, the ponderal index of 43,189 neonates with a gestational age of 40 weeks was compared with the centiles of weight for gestational age to establish alterations in intrauterine growth. Relating the ponderal index with birth weight revealed altered patterns of intrauterine growth in 13 %, 10.3 % and 7.9 % of neonates with appropriate, small and large birth weights, respectively. Moreover, six unusual patters were identified. Use of the ponderal index curve for gestational age together with other growth curves improves the nutritional assessment of newborns. Further studies should be designed to develop strategies for the immediate, medium- and long-term management of identified risk groups.

Management of pregnancies with suspected intrauterine growth retardation in Sweden

Diagnosis and management of intrauterine growth retardation during pregnancy remain a major challenge in obstetric care. The objective of this survey was to evaluate the routine clinical management of pregnancies with suspected intrauterine growth retardation at obstetric departments in Sweden. In 1997, a questionnaire was sent to all 59 obstetric departments in Sweden. Forty-two departments, caring for 83% of all deliveries in Sweden, replied. Four major topics were addressed: definition and diagnosis of intrauterine growth retardation; magnitude of the problem; clinical management; use of Doppler ultrasound in clinical decision-making. Intrauterine growth retardation is diagnosed by a combination of serial fundal height measurements and ultrasonic fetal biometry at 40 departments, two departments perform routine fetal biometry at 32 weeks. The diagnosis is most often made at 32-36 gestational weeks. Five departments use 1.5 s.d. below the mean as cut-off point for diagnosis of small for gestational age fetuses; 35 departments use mean - 2 s.d. and two departments mean - 2.5 s.d. Intrauterine growth retardation is suspected in 1.6-6.3% pregnancies. About 19% of patients with suspected intrauterine growth retardation are hospitalized. On average, 63% of all small-for-gestational age babies are diagnosed prenatally. Thirty-nine out of 42 obstetric departments use formalized management protocols. All departments use cardiotocography, repeat ultrasound scans and Doppler ultrasound for antenatal surveillance. In Swedish obstetric units, the diagnostic procedures and methods of fetal surveillance in pregnancies suspected of intrauterine growth retardation are more or less uniform. Doppler examination of umbilical artery is used at all responding departments and is considered a valuable asset in clinical decision-making.

Complaints and Complications in Pregnancy: A study of ethnic Norwegian and ethnic Pakistani Women in Oslo

Objectives. To describe the pattern of complaints and complications in pregnancy among ethnic Norwegian and ethnic Pakistani women in Oslo in order to modify antenatal care services. Design. A cross-sectional study of hospital patients conducted in community hospitals in Oslo, Norway. A total of 137 obstetrical patients, 66 ethnic Pakistani and 71 ethnic Norwegian women were included in the study. Medical complications and subjective reported physical complaints during pregnancy were the main outcome measures. Results. Among the ethnic Pakistani women complications were more common and the risks were higher for gestational diabetes (crude odds ratio (OR) = 5.6, 95% confidence interval (CI) = 1.5-20.5), intrauterine growth retardation (crude OR = 5.0, 95% CI = 1.4-18.8), hyperemesis gravidarum (crude OR = 3.7, 95% CI = 1.1-12.2) and anaemia (crude OR = 10.2, 95% CI = 3.3-31.4). The frequency of congenital malformations (p = 0.048, OR not calculated) were also higher. Among the ethnic Norwegian women the frequency of subjective reported physical complaints were more common and the risks were higher for pelvic girdle pain (crude OR = 0.4, 95% CI = 0.2-0.8) and exhaustion (crude OR = 0.2, 95% CI = 0.04-0.1). Infections such as hepatitis and tuberculosis only occurred in the Pakistani study group. Conclusion. This study indicates that health personnel delivering antenatal care to women of Pakistani origin need to be watchful for the following conditions: gestational diabetes, hyperemesis gravidarum, early diagnosis of the type of anaemia, fetal malformations and infections like hepatitis and tuberculosis. In addition, a correct diagnosis of intrauterine growth retardation is important. Among ethnic Norwegian women pelvic girdle pain and exhaustion were common complaints .

Insulinlike Growth Factor 1 in Controls and Growth-Retarded Fetuses

Objectives: To establish a reference range of insulinlike growth factor 1 (IGF-1) values in normal fetuses and to assess whether intrauterine growth retardation is associated with increased or decreased IGF-1 levels. Methods: Retrospective analysis of blood samples collected from 64 fetuses who underwent blood sampling at 18–38 weeks’ gestation was performed: 40 fetuses, who were considered controls, were appropriately grown for gestational age and were found unaffected by the condition for which they were tested; the remainder (n = 24) underwent fetal blood sampling to assess fetal karyotype and acid-base balance following ultrasonic diagnosis of intrauterine growth retardation. (In this group, 8 survived, and 16 died during the perinatal period). IGF-1 was measured using a radioimmunoassay after acid-ethanol extraction in order to avoid interference by the binding proteins. All samples from controls and growth-retarded fetuses were measured using the same batch, and the intra-assay coefficient of variation of the test ranged from 4.1 to 6.1%. Results: In control fetuses, IGF-1 serum levels increased linearly with gestational age. In growth-retarded fetuses, IGF-1 levels were not significantly different from the reference range (median Z-score –0.3; range –4.4 to 291) and did not correlate with fetal size, hematocrit, and acid-base balance values. There was a significant difference in IGF-1 and pH values when the fetuses were divided into two groups based on the perinatal outcome: those who survived had values of IGF-1 mostly within the normal range, whereas the fetuses who died in utero or postnatally had significantly decreased pH and elevated IGF-1 values (median Z-score 2.1; 95% confidence interval 0.4–13.9; p = 0.04). Conclusions: This study confirms previous observations that IGF-1 levels parallel the increase in fetal size which occurs with advancing gestation. Increased levels of IGF-1 may indicate a terminal process in the fetal adaptation to placental failure.

Routine screening for intrauterine growth retardation in Germany: low sensitivity and questionable benefit for diagnosed cases.

Antenatal screening for fetal growth retardation has proven effective in detecting at-risk pregnancies under study conditions. It is also widely believed to improve pregnancy outcomes. We assessed sensitivity of antenatal screening routines for intrauterine growth retardation under routine service conditions in Germany. We then compared pregnancy management and outcome in small for gestational age neonates with antenatally diagnosed growth retardation to neonates whose growth retardation had remained undetected. Historical prospective study covering all 2378 singleton pregnancies with antenatal records delivered within a one-year period at a tertiary level maternity hospital in Germany. Antenatal records were linked with pregnancy outcome data. The sensitivity of screening routines based on ultrasound and non-systematic follow-up investigations was 32% as compared to 80-90% reported for ultrasound screening under study conditions. An antenatal diagnosis of intrauterine growth retardation was associated with a 5 times higher rate of preterm delivery (p<0.001), mainly as a consequence of medical interventions to avoid fetal compromise, when compared to new-borns with growth retardation not detected before delivery; admission rates to neonatal care unit were 3 times higher (p<0.001). The proportion of low Apgar scores and low cord pH, indicating fetal distress, was not significantly different in detected and undetected cases. Screening routines for intrauterine growth retardation currently used in Germany miss the majority of cases and do not contribute towards improved pregnancy outcome in detected cases. A benefit of elective preterm delivery in the management of suspected intrauterine growth retardation was not evident.