Doppler assessment of the fetus with intrauterine growth restriction
Diagnosis/definition: IUGR is estimated fetal weight < 10% for gestational age.
Epidemiology/Incidence: 10% of all deliveries, though higher in sub-population.
Risk factors/associations: Not mentioned
Complications: Labor induction, cesarean for abnormal fetal heart rate tracing, neonatal acidosis, stillbirth, perinatal death, impaired intellectual function, and in adulthood hypertension and obesity.
Prevention: Not mentioned
Management: Doppler of middle cerebral artery and ductus venosus has not been sufficiently evaluated to recommend its routine use in daily practice in fetuses with IUGR.
- Preconception counseling: Not mentioned
- Screening/Work-up: Routine UA Doppler screening for subsequent development of IUGR is not recommended.
- Prenatal care: Antenatal corticosteroids should be administered if absent or reverse UA Doppler is noted before 34 weeks.
- Antepartum testing: When IUGR is suspected UA Doppler should be initially done every 1-2 wks; if normal than they can be extended and done less frequently.
- Delivery: With reassuring antepartum surveillance, expectant management until 32 wks for reversed end diastolic flow; until 34 wks for absent end diastolic flow; until 37 weeks for IUGR with decreased UA Doppler, and; until 38-39 weeks for IUGR with normal UA Doppler (Figure 5).
Post-partum/breastfeeding: Not mentioned
Last Reaffirmed: Aug 1, 2015