Intrauterine Growth Restriction: Management

Management

The goal of management of a growth-restricted fetus is to deliver the healthiest possible infant at the optimal time. Continued management of pregnancy with IUGR is based on the results of fetal testing.

Serial evaluations of fetal biometry should be performed every 3 or 4 weeks to follow the extent of growth restriction. Fetal monitoring is important, and may include fetal move-ment counting, nonstress testing, biophysical profiles, and Doppler studies. There are no specific therapies that have proven beneficial for pregnancies complicated by IUGR.

The fetus should be delivered if the risk of fetal death exceeds that of neonatal death, although in many cases these risks are difficult to assess.

For example, a fetus with IUGR with normal anatomic sur-vey, normal amniotic fluid volume, normal Doppler studies, and normal fetal testing may not benefit from early delivery. Conversely, the growth-restricted fetus with serial biometry measurements documenting decreasing growth rate and/or mildly abnormal Doppler studies may benefit from deliv-ery, with or without fetal maturity documentation.

Neonatal management of IUGR infants may partially depend on gestational age, but includes preparation for neonatal respiratory compromise, hypoglycemia, hypo-thermia, and hyperviscosity syndrome. Growth-restricted fetuses have less fat deposition in late pregnancy, so newborn euglycemia cannot be maintained by the normal mechanism of mobilization of glucose by fat metabolism. Hyper-viscosity syndrome results from the fetus’s attempt tocompensate for poor placental oxygen transfer by increas-ing the hematocrit to more than 65%. After birth, this marked polycythemia can cause multiorgan thrombosis, heart failure, and hyperbilirubinemia. Overall, growth-restricted infants who survive the neonatal period have a generally good prognosis.