Intrauterine Growth Restriction in Singleton Pregnancy-Surveillance and Delivery: An Overview
A woman with a growth restricted fetus should be surveyed appropriately and delivered at an optimal time. Pub Med and Cochrane databases have been used and searched for literature on fetal biophysical profile (BPP), cardiotocography (CTG), non-stress test (NST), contraction stress-test (CST) as well as Doppler investigation and indications for delivery. Surveillance of women with IUGR can include BPP, NST and appropriate Doppler blood flow examinations of umbilical arteries and different fetal vessels according to history. Timing of delivery depends on gestational age, degree of IUGR, progression of fetal detoriation, BPP, the NST pattern, the CST response, or fetal Doppler PI (arterial and venous); the indication for delivery must be decided individually. Delivery is indicated in IUGR near term with poor growth over a 2-4 week period, or associated severe maternal preeclampsia. The timing in preterm delivery is controversial. It may be difficult to decide on delivery when the gestational age is less than 32 weeks. If enddiastolic flow is present in UA Doppler flow, and other surveillance findings are normal, the pregnancy may be prolonged. Attempts to temporize intervention appear justified between 25 and 29 weeks gestation because each day in utero may reduce neonatal mortality by 1-2 %.
Keywords: Intrauterine growth restriction, biophysical profile, non stress test, computerized CTG, contraction stress test, Doppler ultrasound, delivery
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