Abstract

INTRAUTERINE GROWTH RESTRICTION: ETIOLOGICAL ASSESSMENT

Sanae Stimou*, Hafsa Taheri, Hanane Saadi and Ahmed Mimouni

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Abstract

Introduction: The management and etiological workup of a fetus small for gestational age (SGA) and/or suspected of intrauterine growth restriction (IUGR) is a common and complex problem in obstetrics. Material and Methods: Medline, Embase and the Cochrane Library were searched using a combination of the terms SGA, IUGR, fetal weight, ultrasound, management, etiology, and examinations. Some references, not selected by this strategy but associated with these publications or suggested by working group members, were also added. The relevant articles were used to establish this text of recommendations after discussions between experts of the working group. Results: Once the diagnosis of SGA has been made (whether based on clinical, ultrasound, or Doppler criteria), an etiological workup must be proposed and discussed with the parents (expert opinion). This workup, whose scope varies according to the presentation of the case (term, severity, other ultrasound anomalies), is only meaningful if it is likely to modify the management of the pregnancy during and after delivery and/or potentially reduce perinatal and long-term morbidity. The clinical and paraclinical work-up (in particular ultrasound) has two main objectives: to evaluate the fetal vitality and the possibilities of continuing the pregnancy in safe conditions for the mother and the fetus; to establish the origin of this SGA. It is this second part that is detailed in this chapter of the recommendations. The more severe and early the biometric abnormality, the more extensive the etiological work-up should be. When there are fetal Doppler abnormalities or maternal vascular symptomatology, management should be performed as an emergency. Conclusion: The etiological workup should be rigorous and systematic. In all cases, the practitioner should provide clear information to the parents and perform a workup that should always include a detailed questioning, in particular the history and data from the beginning of the pregnancy, a clinical examination, and a morphological ultrasound. Complementary examinations, and in particular invasive fetal sampling, should be performed according to the clinical and ultrasound orientations and in consultation with the different professionals involved.

Keywords: IUGR; SGA; Doppler; Ultrasound.