Intrauterine growth restriction--diagnosis and management.

BACKGROUND: Fetal growth disorders are an important cause of perinatal morbidity and mortality with long term health implications for the survivors of intrauterine growth restriction (IUGR). The accurate assessment of fetal growth during pregnancy is difficult, but recent advances have improved this important aspect of obstetric care with positive implications for antenatal patients and their babies.

OBJECTIVE: This article provides an overview of the detection of fetal growth problems in pregnancy, the determination of the likely cause, and the antenatal and intrapartum care of women with pregnancies identified as being affected by IUGR. The role of customised fetal growth assessment in the detection of IUGR is considered and followed by an outline of the appropriate monitoring and management of these pregnancies based on the underlying pathophysiology.

DISCUSSION: Accurate assessment of fetal growth is improved by early clarification of gestational age and the use of customised fetal growth charts. Once infections and anomalies have been excluded, it is imperative to distinguish the healthy small fetus from the growth restricted fetus. While treatment options are limited, the optimal management of the IUGR affected fetus aims to achieve the delivery of the newborn in the best possible condition, balancing the risks of prematurity against those of continued intrauterine existence.