Intrauterine growth retardation: characteristics, risk factors and gestational age

Maternal, obstetrical, and neonatal factors were studied in 1604 pregnancies complicated by intrauterine growth retardation and 1604 non-IUGR controls. These were examined in the overall IUGR group and at various gestational ages. Eighty-six percent of perinatal deaths were found in the IUGR group with 57.4% occurring prior to labor. Maternal smoking, low weight gain, low prepregnancy weight, and hypertension were found more frequently in the IUGR population. In addition, maternal hypertension was found to be significant in the IUGR infants delivered prematurely.     

The efficacy of biochemical assays in assessing an IUGR risk-group, preselected with ultrasound fetometry

Dehydroepiandrosterone sulphate, progesterone, estradiol, estriol and human placental lactogen (hPL) were biochemically assayed in a group of 92 pregnancies in which intra-uterine growth retardation was suspected. The group was selected with ultrasound fetometry at 32 weeks of gestation, and maternal blood was sampled at 33, 35, 37 and 39 weeks of gestation. The IUGR group consisted of 30 pregnancies resulting in the birth of an infant with a birthweight of 2 standard deviations or more below the mean for gestational age in the Malm? population. Intra-uterine growth trends were defined by serial ultrasound fetometry performed every second week. Both serum hormone and hPL content were examined in relation to birth-weight, occurrence of imminent asphyxia at delivery, Apgar score, and pH in the umbilical vein. Neither dehydroepiandrosterone sulphate, nor progesterone nor estradiol values correlated to any of the outcome variables. To some extent estriol values distinguished IUGR from non-IUGR fetuses but not until the 39th gestational week, whereas hPL was effective in this respect in all weeks studied. An hPL value below 4 mg/l predicted IUGR with a sensitivity ranging from 52% to 74%, and a specificity ranging from 85% to 78%. HPL correlated well with the subsequent intra-uterine growth rate, but not with the outcome variables studied.     

The relationship between mean abdominal diameter and femur length in normal and impaired fetal growth

The relationship of fetal mean abdominal diameter (MAD) to fetal femur length (FL) in clinically normal pregnancies and 37 cases of intrauterine growth retardation (IUGR) was studied. The normal relationship of FL to MAD is closely described by the equation: log (MAD) = 3.326 + (0.185 X FL). r = .953, P less than .001. In the growth retarded infants, 59% of the abdominal measurements fell below the lower 75% confidence limit. Of the abdominal measurements derived from infants with birthweight greater than 2 SD below the mean for gestational age, 86% fell below the lower 75% confidence limit. These data show the MAD is selectively depressed in many, but not all cases of IUGR and particularly in the more severely affected infant, but the technique is not sufficiently discriminant to be used by itself for the detection of IUGR. Detection of an anomaly of this relationship would be strong supportive evidence of IUGR independent of gestational age and possibly identifies infants growth retarded specifically due to chronic deprivation.     

The association between oligohydramnios and intrauterine growth retardation

Among 147 cases of suspected intrauterine growth retardation (IUGR) identified based upon ultrasonic abdominal circumference below the tenth percentile, 56 were confirmed IUGR infants at birth and 91 were non-IUGR infants. Eight of 316 control fetuses with abdominal circumference above the tenth percentile turned out to be IUGR infants at birth. The incidence of oligohydramnios was strikingly different among the three groups: 29% for the IUGR group, 9% for the non-IUGR group, and 0.6% for the controls (P less than .001). When the criteria of abdominal circumference below the tenth percentile and presence of oligohydramnios were used together, the positive predictive value doubled (from 38.1 to 66.7%; P less than .01). Oligohydramnios developed some time after the somatic evidence of fetal growth retardation in all cases in this study. Finally, there were no significant differences between fetal growth retardation with or without oligohydramnios with respect to maternal risk factors or fetal outcome. We conclude that in fetal growth retardation, the occurrence of oligohydramnios during the third trimester of pregnancy is not associated with worse fetal outcome.     

Correlation of confined placental mosaicism with fetal intrauterine growth retardation. A case control study of placentas at delivery

OBJECTIVE: Our purpose was to determine if the frequency of confined placental mosaicism in newborns with unexplained intrauterine growth retardation (IUGR) was higher compared with infants with appropriate growth in utero and the outcome of these pregnancies. STUDY DESIGN: A total of 20 cases with unexplained IUGR and 20 cases with appropriate growth for gestational age has been studied. Amnion, chorion and villi biopsy specimens were obtained from growth-retarded cases and controls at delivery. Cord blood specimens for 48-hour lymphocyte cultures were obtained from all infants with IUGR. RESULTS: Karyotype analysis revealed confined placental mosaicism in two of 20 (10%) cases with IUGR. In one growth retarded case and one appropriate growth for gestational age case, mosaicism was also confirmed in the amnion. Cytogenetic analysis from peripheral blood of newborns showed normal karyotype in all cases. Three pregnancies in the group of fetuses with IUGR (15%) ended with fetal death compared with normal fetal surveillance of all cases from the control group. CONCLUSION: Confined placental mosaicism was detected two times more frequently from placentas of growth- retarded infants compared with those of newborns with appropriate growth. The fetal loss was significantly higher in the group of cases with IUGR compared with the control group.     

Placental vessel morphometry in growth retardation and increased resistance of the umbilical artery Doppler flow

OBJECTIVES: To study the tertiary-stem villi vessel lumen and wall thickness of placenta in pregnancy complicated with placental insufficiency and intrauterine growth retardation (IUGR), its correlation with the umbilical artery Doppler flow study, and compare with normal and non-IUGR pregnancies. METHODS: Placentas from 45 deliveries (between 28 and 38 weeks) were collected for morphometric study of the tertiary-stem villi vessels. Each pregnancy had clinical suspicion of IUGR and was confirmed by serial ultrasound biometry, HC/AC ratio, and had abnormal umbilical artery Doppler velocimetry (RI). Each placenta was weighed after trimming of the membrane and the cord. Sections of the placenta (4 micron) were stained with hematoxylin and eosin and periodic acid-Schiff reagents. Tertiary-stem villi vessels were identified under a microscope (x40) and morphometric study was performed. Inner and outer circumferences (2.pi.r) were measured, radii (r) were calculated, and vessel wall thickness was determined (outer r - inner r). These findings were compared with the findings from 78 placentas from normal pregnancies (between 28-40 weeks) and 27 placentas from pregnancies with medical complications without IUGR (non-IUGR) and with normal Doppler velocimetry (between 33 and 38 weeks). RESULTS: Weight of placentas were significantly (P < 0.005) lower in IUGR than the normal and non-IUGR groups. The vessel wall thickness was significantly (P < 0.0001) increased in IUGR group (mean 21.17 +/- 3.16 micron [SD]) compared to normal and non-IUGR groups (mean 13.19 +/- 1.66 micron). With advancing gestational age, the thicknesses of vessel walls in all groups were significantly (P < 0.001) decreased. There was significant (P < 0.001) decrease in lumen circumference in the IUGR group (mean 173 +/- 31 micron) compared to normal and non-IUGR groups (mean 69 +/- 23 micron). Significant (P < 0.001) correlation was observed between the thickness of a vessel wall and the increase in Doppler RI. CONCLUSIONS: Pregnancies with growth retardation are associated with smaller placentas, increase in the thickness of tertiary-stem villi vessel wall, and decrease in lumen circumference. These changes are associated with an increase in the resistance index of the umbilical artery Doppler flow velocimetry.     

Maternal serum alpha-fetoprotein (MSAFP) and fetal growth

Early mid-trimester screening of maternal serum alpha-fetoprotein (MSAFP) for the detection of neural tube defects is becoming a routine part of obstetrical care. In singleton pregnancies in the absence of fetal chromosomal abnormalities and anatomical anomalies high levels of AFP have been variably related to increased risk for low birthweight infant outcome. The overall relationship, if any, of maternal serum AFP to infant birthweight has, however, not been previously characterized. Between 15 and 20 weeks gestation, MSAFP values were determined for 110 women carrying single, anatomically and karyotypically normal fetuses. Statistical analysis utilizing polynomial and multilinear regression was used to determine the relationship of early mid-trimester MSAFP first to neonatal birthweight and then to gestational age and birthweight adjusted for gestational age. For every increase of one multiple of the median in MSAFP, neonatal birthweight fell 322 grams. This was accounted for almost entirely by decreased fetal growth; early mid-trimester MSAFP was linearly related to birthweight adjusted for gestational age ten times more strongly than to gestational age alone. The explanation for this relationship remains speculative, but the utility of routine AFP screening for the antenatal detection of intrauterine growth retardation certainly deserves further study.     

Doppler umbilical velocimetry in the prediction of adverse outcome in pregnancies at risk for intrauterine growth retardation

Perinatal indicators of fetal compromise were assessed according to the results of continuous-wave Doppler umbilical velocimetry for 172 patients at risk for intrauterine growth retardation (IUGR). Forty-three (25%) of the patients delivered an infant with a birth weight below the tenth percentile for gestational age. The last Doppler study before delivery was abnormal in 48.8% of the growth-retarded infants but in only 13.2% of the infants without evidence of IUGR. Furthermore, in the growth-retarded group, early delivery, reduced birth weight, decreased amniotic fluid at birth, admission to the neonatal intensive care unit, neonatal complications associated with IUGR, and a prolonged hospital stay were observed more frequently in those who had an abnormal ratio than in those with a normal ratio. The sensitivity of the systolic/diastolic ratio for an adverse perinatal outcome (operative delivery for fetal distress, neonatal morbidity associated with IUGR, and/or perinatal death) was significantly better for the infants with IUGR (66.7%) than for the infants without IUGR (27.8%; P less than .05). The predictive value of an abnormal ratio was also higher for the pregnancies complicated with IUGR (57.1%) than for those without IUGR (29.4%), but not to a statistically significant degree. These data suggest that Doppler umbilical velocimetry studies are valuable in identifying those growth-retarded fetuses at increased risk for an adverse perinatal outcome.     

Placental Vessel Morphometry in Growth Retardation and Increased Resistance of the Umbilical Artery Doppler Flow

Objectives: To study the tertiary-stem villi vessel lumen and wall thickness of placenta in pregnancy complicated with placental insufficiency and intrauterine growth retardation (IUGR), its correlation with the umbilical artery Doppler flow study, and compare with normal and non-IUGR pregnancies. Methods: Placentas from 45 deliveries (between 28 and 38 weeks) were collected for morphometric study of the tertiary-stem villi vessels. Each pregnancy had clinical suspicion of IUGR and was confirmed by serial ultrasound biometry, HC/AC ratio, and had abnormal umbilical artery Doppler velocimetry (RI). Each placenta was weighed after trimming of the membrane and the cord. Sections of the placenta (4μ.) were stained with hematoxylin and eosin and periodic acid-Schiff reagents. Tertiary-stem villi vessels were identified under a microscope (±40) and morphometric study was performed. Inner and outer circumferences (2.π.r) were measured, radii (r) were calculated, and vessel wall thickness was determined (outer r—inner r). These findings were compared with the findings from 78 placentas from normal pregnancies (between 28-40 weeks) and 27 placentas from pregnancies with medical complications without IUGR (non-IUGR) and with normal Doppler velocimetry (between 33 and 38 weeks).

Results: Weight of placentas were significantly (P < 0.005) lower in IUGR than the normal and non-IUGR groups. The vessel wall thickness was significantly (P < 0.0001) increased in IUGR group (mean 21.17 ± 3.16 μ [SD]) compared to normal and non-IUGR groups (mean 13.19 ± 1.66 μ). With advancing gestational age, the thicknesses of vessel walls in all groups were significantly (P < 0.001) decreased. There was significant (P < 0.001) decrease in lumen circumference in the IUGR group (mean 173 ± 31 μ) compared to normal and non-IUGR groups (mean 69 ± 23 u,). Significant (P < 0.001) correlation was observed between the thickness of a vessel wall and the increase in Doppler RI.

Conclusions: Pregnancies with growth retardation are associated with smaller placentas, increase in the thickness of tertiary-stem villi vessel wall, and decrease in lumen circumference. These changes are associated with an increase in the resistance index of the umbilical artery Doppler flow velocimetry.     

Importance of ductus venosus Doppler assessment for fetal outcome in cases of intrauterine growth restriction

OBJECTIVE: The measurement and evaluation of ductus venosus (DV) blood flow velocity waveform in high-risk pregnancies has been studied intensively in recent years in order to find a more intermediate signal of fetal compromise. Our objective was to study the fetal outcome of pregnancies with intrauterine growth retardation (IUGR) and normal pulsatility of DV compared to an IUGR group with increased DV pulsatility. METHODS: The outcome of 42 fetuses before 32 weeks of gestational age without chromosomal or structural aberrations was analyzed. All fetuses showed IUGR <5th percentile based on placental insufficiency diagnosed by pathologic RI >90th percentile of both maternal uterine arteries. One group (30 fetuses; mean weight 730 g/SD 190 g; mean gestational age 197 days/SD 12 days) showed normal, the other (12 fetuses, mean weight 675 g/SD 179 g; mean gestational age 198 days/SD 12 days) reduced, but neither absent nor reverse DV flow during atrial contraction. All 42 fetuses were delivered by cesarean section because of severe variable or prolonged decelerations. We measured blood flow velocities of the DV in every fetus on an average 3.7 days (range 1-5 days) before cesarean section. Fetal outcome was determined by Apgar scores after 5 and 10 min, arterial pH and base excess; neonatal morbidity was recorded by intensive follow-up. RESULTS: There were no significant differences of pH, umbilical artery base excess, Apgar scores and severe neonatal complications between the two groups. CONCLUSIONS: Our own data show no correlation between increased pulsatility in the DV (without absent or reverse flow during atrial contraction) and fetal outcome before 32 gestational weeks, even in cases of severe growth restriction based on placental insufficiency. Therefore in these cases reduced DV flow during atrial contraction should cautiously be interpreted regarding obstetrical decisions.     

Gene expression patterns of the 11β-hydroxysteroid dehydrogenase 2 enzyme in human placenta from intrauterine growth restriction: the role of impaired feto-maternal glucocorticoid metabolism

Objective

To assess 11-β-hydroxysteroid dehydrogenase 2 (11β-HSD2) gene expression patterns in human placental samples from intrauterine growth restriction (IUGR) pregnancies using normal pregnancy as control.

Study design

We compared 11-β-HSD2 gene expression in placental samples from all IUGR pregnancies treated in our clinic between January 1, 2010 and January 1, 2011 vs. 140 normal pregnancy samples from the same study period. Clinical characteristics were also assessed and compared between the IUGR and normal pregnancy groups.

Results

Mean gestational weight gain in the IUGR group was significantly lower than in the control group. Similarly, change in body mass index (BMI) was lower. Impending intrauterine fetal asphyxia was significantly more common in the IUGR group. The 11β-HSD2 gene was underexpressed compared to controls, but this underexpression was only observed after the 33rd gestational week. Within the IUGR group, in cases of impending intrauterine fetal asphyxia the 11β-HSD2 gene was underexpressed compared to both impending asphyxia in non-IUGR cases, or IUGR without impending asphyxia.

Conclusion

Low gestational weight gain appears to predict IUGR. The 11β-HSD2 gene in IUGR is underexpressed and may result in an impaired placental barrier, decreasing protection against maternal glucocorticoids, which are thought to be prominent in fetal programming. Maternal glucocorticoid exposure resulting from an impaired placental barrier may increase the risk for cardiovascular and metobolic disorders later in adult life. In IUGR, before the 33rd gestational week, the expression of the 11β-HSD2 gene remains physiological. The underexpression of this gene after the 33rd week in impending intrauterine fetal asphyxia in IUGR points to an increased sensitivity to hypoxia when impending asphyxia is present in the late phase of IUGR pregnancies.     

Intrauterine growth retardation--a prospective study of the diagnostic value of real-time sonography combined with umbilical artery flow velocimetry

This study was undertaken to evaluate the role of umbilical artery flow velocimetry combined with sonographic estimation of fetal weight, head circumference to abdominal circumference ratio, femur length to abdominal circumference ratio, and qualitative determination of amniotic fluid volume as a comprehensive test for the detection of intrauterine growth retardation (IUGR). The following cutoff values were used to indicate abnormal test results: 1) umbilical artery peak systolic to end-diastolic ratio (S/D) above 3, 2) estimated fetal weight below the tenth percentile for gestational age, 3) head circumference to abdominal circumference ratio more than 2 SD above the mean for gestational age, 4) femur length to abdominal circumference ratio above 23.5%, and 5) qualitative amniotic fluid volume less than 2 cm. The study population consisted of 127 patients referred with a clinical suspicion of IUGR. Forty-five infants (35%) were small for gestational age. None of these five tests were uniformly successful in identifying growth-retarded infants. Overall, the best predictor appeared to be estimated fetal weight below the tenth percentile for gestational age, which correctly identified 39 of the 45 IUGR infants (sensitivity 87%, specificity 87%). The sensitivity of this test was nearly twice that of any other test. All indices performed similarly in predicting the non-IUGR infant (range of specificities 87-98%).     

Placental pathology of idiopathic intrauterine growth retardation at term.

Placental examination was carried out in 128 consecutive cases of idiopathic intrauterine growth retardation (IUGR) at term and the findings were compared with those of 179 gestational age-matched cases with normal growth. Mean pregnancy weight and mean maternal weight gain during pregnancy of IUGR cases were both significantly lower than for non-IUGR cases. There was a higher frequency of a history of previous growth-retarded infants between IUGR cases (18 of 128, or 14%) compared with non-IUGR cases (7 of 179, or 3.9%). The studied placental lesions were placental infarction, chronic villitis, hemorrhagic endovasculitis, and placental vascular thromboses. One or more of these lesions were present in 71 of 128 (55%) of IUGR cases, and 58/179 (32%) of non-IUGR cases. Thirty-eight of 72 (53%) cases with chronic villitis were IUGR (30% of all IUGR cases). Thirty-one of 49 cases (63%) with placental infarction were IUGR cases (24% of all IUGR cases). Nineteen of 32 cases (59%) with hemorrhagic endovasculitis were IUGR cases (15% of all IUGR cases). Twelve of 17 cases (71% with placental vascular thromboses were IUGR (9% of all IUGR cases). Relationships of all placental lesions to IUGR were independent of each other. IUGR infants more frequently had multiple types of lesions in their placentas. Chronic villitis and hemorrhagic endovasculitis tended to occur in the same placentas. There were no significant relationships between maternal characteristics and placental lesions, except for an association between low pregravid weight and increased incidence of placental infarction. Decreased birth length was associated only with placental infarction (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

表皮生长因子与胎儿宫内发育迟缓关系的研究

探讨表皮生长因子与胎儿宫内发育迟缓的关系。方法用放射免疫分析,测定８６例妊娠晚期妇女血清,羊水和脐静脉血ＥＧＦ浓度;根据新生儿出生体重,将研究对象分成对照组５４例,大于胎龄儿组１８例和ＩＵＧＲ组１４例。对照组中有１１例同时测定脐动脉血清ＥＧＦ浓度,比较各组间羊水和孕妇,脐血清ＥＧＦ水平及脐动,静脉血清间ＥＧＦ水平的差异。     

Intrauterine growth in twin pregnancies: prediction of fetal growth retardation

In 80 consecutive twin pregnancies, prenatal measurements of fetal biparietal diameter (BPD) and abdominal diameter were made and growth curves were calculated using routine ultrasound examinations. Nineteen percent of the infants were growth retarded. Growth retardation was found in both fetuses in four pregnancies and in one fetus in 22 other pregnancies. Linear regression analysis between birth weight and gestational age showed the standard deviation of birth weight to be proportional to gestational age. A more linear growth curve also was found when the mean fetal weight was calculated by use of the BPD and abdominal diameter measurements in the formula developed for singletons. The estimated weight compared with birth weight in 62 twins who had ultrasound examinations less than seven days before delivery showed a significant correlation (r = 0.89, P less than .001) with a coefficient of variation of 12.4%. The identification of intrauterine growth retardation (IUGR) in twin pregnancies by ultrasound had a sensitivity of 62%, a specificity of 98%, and a predictive value of positive and negative test of 93% and 83%, respectively.     

Placental gene expression patterns of epidermal growth factor in intrauterine growth restriction

Objective

In this study, we compared human placental gene expression patterns of epidermal growth factor (EGF) in pregnancies with intrauterine growth restriction (IUGR) vs. normal pregnancies as control.

Study design

Gene expression of EGF was determined from human placental samples collected from all pregnancies presenting with IUGR at our institution during the study period January 1, 2010–January 1, 2011. Multiple clinical variables were also assessed including maternal age, gestational weight gain, increase of BMI during pregnancy and fetal gender.

Results

A total of 241 samples were obtained (101 in the IUGR pregnancy group, 140 in the normal pregnancy group). EGF was found to be underexpressed in the IUGR group compared to normal pregnancy (Ln2^α: −1.54; p < 0.04). Within the IUGR group no fetal gender-dependent difference was seen in EGF gene expression (Ln2^α: 0.44; p < 0.06). Similarly, no significant difference in EGF expression was noted in cases with more vs. less severe forms of IUGR (Ln2^α: −0.08; p = 0.05). IUGR pregnancies were significantly more common in the maternal age group 35–44 years compared to other age groups. Gestational weight gain and gestational BMI increase were significantly lower in IUGR pregnancies compared to controls.

Conclusions

Placental expression of EGF was found to be reduced in IUGR pregnancies vs. normal pregnancies. This may partly explain the smaller placental size and placental dysfunction commonly seen with IUGR. An increased incidence of IUGR was observed with maternal age exceeding 35 years. The probability of IUGR correlated with lower gestational weight gain and lower BMI increase during pregnancy.     

Effectiveness of detection of intrauterine growth retardation by abdominal palpation as screening test in a low risk population: an observational study

OBJECTIVE: To evaluate the performance of abdominal palpation as a screening test for intrauterine growth retardation (IUGR) in a low risk population, under standard practice conditions. STUDY DESIGN: Population based observational study of 6318 consecutive low risk singleton pregnancies. The Dutch obstetric system distinguishes low from high risk pregnancies. In the low risk group abdominal palpation as a screening test is performed by midwives. If a complication, like IUGR, during prenatal care is assessed, the women is referred to a consulted obstetrician. Ultrasound is performed by the consulted obstetrician. In case of sustained suspicion the women is selected as high risk. Outcome parameters: severe small for gestational age (SGA) birthweight below 2.3rd centile, all SGA birthweight below 10th centile, operative delivery, neonatal morbidity and perinatal mortality. Screening value of abdominal palpation, abdominal palpation combined with ultrasound, and the performance of high risk selection was assessed by conventional performance measures. RESULTS: Abdominal palpation as a screening test for IUGR is of limited value: the observed sensitivities were 28% for severe SGA and 21% for SGA p < or = 10, respectively. After ultrasound in case of sustained suspicion, the sensitivity in detection of severe SGA was 25% and positive predictive value (PPV) 16%. In detection of SGA p < or = 10 sensitivity was 15% and PPV 55%, which means 45% were false positives. The sensitivity of the Dutch obstetric system in selection of high risk pregnancies in detection of severe SGA was 53%, in detection of SGA p < or = 10 was 37%. Perinatal mortality was 0.9% (57/6318) and 32% of these cases were SGA. Six cases of fetal death were unrecognised during prenatal care (0.09%) and seem preventable. The prevalence of a 5 min Apgar Score < or = 7 was significantly higher in the SGA infants if SGA was defined as p < or = 10. CONCLUSIONS: The diagnostic performance of abdominal palpation as a screening test for IUGR detection in a low risk population is disappointing. However, various stratagems such as routine ultrasound do not improve detection rate or perinatal morbidity and mortality.     

Sonographic diagnosis of intrauterine growth retardation using the postnatal ponderal index and the crown-heel length as standards of diagnosis

One hundred twenty-one patients underwent an ultrasound examination within 48 hours of delivery to assess prospectively the reliability of the diagnosis of intrauterine growth retardation. Sonographic parameters examined included the abdominal circumference, sonographic estimate of fetal weight, the head to abdominal circumference ratio, and the femur length to abdominal circumference ratio. The best obstetric estimate of gestational age was used. The diagnosis of growth retardation was based on the postnatal ponderal index, and or the birthweight and crown-heel length percentiles. Seventeen infants were growth retarded. Fifteen infants had a birthweight less than the 10th percentile, but only nine (60%) were either asymmetrically growth retarded (by their ponderal index) or symmetrically growth retarded (by virtue of a birthweight and length less than the 10th percentile). All sonographic parameters were better able to predict a birthweight below the 10th percentile for gestational age than growth retardation. An abdominal circumference less than the 2.5 percentile for gestational age had the highest sensitivity for growth retardation (88.0%) of the parameters studied. Only the abdominal circumference centile identified all infants with either symmetric growth retardation or asymmetric growth retardation associated with a birthweight below the 10th percentile. A sonographic estimate of fetal weight below the 10th percentile had the highest positive predictive value for growth retardation--38%. In contrast to the overall poor positive predictive values, the negative predictive values for all parameters studied exceeded 90%. Combining the abdominal circumference percentile with one of the three remaining techniques did not significantly improve diagnostic accuracy.(ABSTRACT TRUNCATED AT 250 WORDS)     

Growth restriction as a determinant of outcome in preterm discordant twins

OBJECTIVE: To estimate the influence of intrauterine growth restriction (IUGR) on the outcome of preterm discordant twins. METHODS: Medical records of preterm twins born at 24-34 weeks of gestation between 1995 and 2000 were reviewed. Significant discordancy was defined as more than 15% difference in birth weight. Small for gestational age (SGA) was defined as birth weight less than 10th percentile, according to a twin-adjusted gestational age nomogram. The smaller twins of 96 discordant twin pairs were evaluated. The SGA-discordant group included the smaller twin of a discordant pair who was also SGA (n = 46); the appropriate-for-gestational-age (AGA)-discordant group included the smaller twin of a discordant pair who was appropriate for gestational age (n = 50). RESULTS: Maternal age, incidence of maternal hypertension, antenatal steroids, and gestational age at delivery were similar between groups. Delivery for suspected fetal compromise complicated significantly more pregnancies in the SGA-discordant group than in the AGA-discordant group (45.6% versus 16%, P = .005), as did respiratory distress syndrome (RDS) (37% versus 8%, P < .05) and intraventricular hemorrhage (21.7% versus 6%, P = .024). Mortality or severe neonatal morbidity (defined as severe RDS, intraventricular hemorrhage grades 3-4, or necrotizing enterocolitis) were significantly higher among neonates in the SGA-discordant group than in the AGA-discordant group (19.5% versus 6%, P = .04). The risk for major morbidity was 7.7-fold greater in the SGA-discordant than in the AGA-discordant group, adjusted for gestational age. CONCLUSION: Growth restriction in preterm discordant twins is associated with a 7.7-fold increased risk for major neonatal morbidity. Therefore, discordant twins with IUGR require closer monitoring than discordant twins without IUGR.     

Differentiation of growth retarded from normally grown fetuses and prediction of intrauterine growth retardation using Doppler ultrasound

Objective To assess the hypothesis that infants exhibiting catch-up growth as an indicator of intrauterine growth retardation (IUGR) have a higher incidence of predelivery abnormal Doppler results.
Setting Obstetric unit, St James's University Hospital, Leeds.
Participants One hundred and ninety-six women with singleton pregnancies at high risk of IUGR, delivered between October 1992 and August 1993.
Main outcome measures Postnatal catch-up growth during the first seven months.
Results Forty-six of the 196 infants demonstrated catch-up growth and were therefore classified as growth retarded; 85% of this group had had abnormal Doppler results prior to delivery, compared with 14% of the normally grown group. However, there is considerable overlap in birthweight ratio distribution between the two groups.
Conclusion This study confirms the existence of a population of IUGR infants of average birthweight ratio. Doppler appears to distinguish IUGR (as defined by catch-up growth) from normal growth more successfully in infants with an average birthweight ratio than in infants with a low birthweight ratio and is a better predictor of IUGR than SGA.