Intrauterine Growth Restriction

Minimize all medication use during pregnancy, especially in 1st TM, unless clearly indicatedDefinition

FDASonographic pregnancyEFW categories<10th percentile

A: No risk in controlled human studiesEtiology

B:Maternal Nofactor: riskBehavioral in(smoking, controlledsubstance animaluse, studies,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 noconsider riskdelivery seenif inpoor humans
  NST/AFI/BPP

  C:, Smallabdominal riskcirc in<4 controlledwks animalbiparietal studies,diameter, but not seenoligo or notdoppler studiedumbilical inartery humansend diastolic flow zero or reversed

Pocket Obstetrics and gynecology by K Joeph Hurt 2nd edition

D: Strong evidence of risk in humans, but benefit may outweigh risk

X: High risk - never to be used in pregnant humans

Keyword: Name of drug (1st/2nd/3rd TM FDA category)

Analgesics

Acetaminophen (B/B/B), Ibuprofen (B/B/D),