Intrauterine Growth Restriction

Definition

Sonographic EFW <10th percentile

Etiology

Maternal factor: Behavioral (smoking, substance use, decrease nutritional intake), Medical (Diabetes, HTN, renal insufficiency, autoimmune), extreme of maternal age

Fetal factor: Chromosomal or genetic cause, fetal infection, multiple gestations

Physical examination

Suspect if fundal height < dates or poor maternal weight gain

Magagement

• Growth ultrasounds every 2-3 weeks
• Antenatal testing
  • twice weekly NST to once weekly BPP with NST or weekly NST with weekly AFI
  • Umbilical artery doppler weekly
• Perinatology consult and consider delivery if poor NST/AFI/BPP , abdominal circ <4 wks biparietal diameter, oligo or doppler umbilical artery end diastolic flow zero or reversed

Pocket Obstetrics and gynecology by K Joeph Hurt 2nd edition