Neonatal morphometrics and perinatal outcome: who is growth retarded?

To evaluate the relationship between neonatal morphometrics and poor neonatal outcome resulting from fetal malnutrition, we prospectively examined 355 sequential live-born, singleton neonates greater than 35 weeks' gestational age. Birth weight, neonatal ponderal index, and midarm circumference to head circumference ratio were measured. A birth weight, ponderal index, or midarm circumference to head circumference ratio less than or equal to tenth or greater than or equal to ninetieth percentiles for gestational age was considered abnormal. Poor outcome was defined as operative delivery for fetal distress, 5-minute Apgar score less than 7, meconium aspiration, polycythemia, or hypoglycemia. Thirty-three (9.3%) neonates had perinatal morbidity. Although morbidity was not increased among neonates that were large by any of the criteria, five (25%) of 20 with low birth weight had poor outcome and 18 (26%) of 70 with low ponderal index or midarm circumference to head circumference ratio suffered morbidity. Of the 33 neonates with morbidity, 18 (54.5%) had low ponderal index or midarm circumference to head circumference ratio, but only five (15.2%) had low birth weight. Therefore, low ponderal index and midarm circumference to head circumference ratio are more sensitive predictors of outcome than is birth weight. As such, ponderal index and midarm circumference to head circumference ratio are more appropriate end points for antenatal diagnostic studies than is birth weight.     

Influence of fetal fat on the ultrasound estimation of fetal weight in diabetic mothers.

Currently available formulas for the estimation of fetal weight assume uniform density of tissue. Because fat tissue is less dense than lean body mass, we hypothesized that the sonographic overestimation of fetal weight in infants of diabetic mothers is the consequence of an elevated proportion of body fat, resulting in a lower body density. We prospectively examined 52 children of diabetic mothers. Each had ultrasound estimation of fetal weight within 7 days of delivery and estimates of neonatal body composition made from anthropometric evaluation within 48 hours of birth. Ultrasound estimates of fetal weight were considered acceptable if they were within 10% of actual birth weight. There was no difference in mean birth weight between those overestimated (N = 22) and those underestimated (N = 8). The sum of skinfolds from two sites, the ponderal index, and percent body fat were all significantly greater in the neonates with sonographic overestimation of fetal weight. Lean body mass was significantly greater (P less than .05) in infants whose sonograms underestimated birth weight. When all subjects were included, a significant correlation was found between the degree of error in the ultrasound estimation of fetal weight and the ponderal index (r = 0.40, P less than .01), the sum of the skinfold measurements (r = 0.29, P less than .05), and the present body fat (r = 0.28, P less than .05). These data suggest that increased body fat in infants of diabetic mothers is associated with sonographic overestimation of fetal weight.     

Evaluation of fetal growth by estimation of neonatal body composition.

To characterize the variation in normal fetal growth by body composition analysis, 188 neonates from uncomplicated singleton term pregnancies were evaluated within 24 hours of birth. Anthropometric measures used to estimate lean body mass and body fat included the following: birth weight 3553 +/- 462 g, lean body mass 3060 +/- 377 g (86.3%), fat mass 495 +/- 196 g (13.7%), and ponderal index 2.65 +/- 0.25. There was a significant linear correlation between birth weight and lean body mass (r2 = 0.83, P = .0001), fat mass (r2 = 0.46, P = .0001), and ponderal index (r2 = 0.22, P = .001). Although the ponderal index has been used as an index of corpulence, the correlation between ponderal index and percent body fat was poor (r2 = 0.15). These results suggest that although neonatal fat mass constitutes only 14% of total birth weight, it explains 46% of its variance. In contrast, the ponderal index explains only 22% of the variance in birth weight and correlates poorly with percent body fat. Body composition analysis explains a significant amount of the variance in normal birth weight.     

Factors associated with fetal growth and body composition as measured by ultrasound

OBJECTIVE: This study seeks to determine which parental demographic and metabolic factors best correlate with fetal growth and body composition as estimated by ultrasound. STUDY DESIGN: Thirty-one gravid patients had ultrasound estimates of fetal anthropometry in mid-third trimester. These measurements included estimated fetal weight, abdominal subcutaneous fat, and/or thigh subcutaneous fat thickness. Independent variables included diagnosis of gestational diabetes, parental demographic factors, neonatal sex, and late gestation estimates of carbohydrate metabolism. RESULTS: In the multivariate stepwise model the strongest predictor of ultrasound estimated fetal weight was basal hepatic glucose production, followed by late gestation insulin sensitivity (total R (2) = 0.27). The strongest predictors of abdominal subcutaneous fat thickness were weight gain and presence of gestational diabetes (total R (2) = 0.25). CONCLUSION: Measures of maternal carbohydrate metabolism, rather than fat mass, explain sonographic measurements of fetal weight. We speculate that factors other than maternal carbohydrate metabolism further explain the variances of fetal adiposity.     

Interval between fetal measurements in predicting growth restriction

OBJECTIVE: To determine the influence of the interval between fetal measurements on performance of fetal growth velocity for predicting infants with anthropometric features of fetal growth restriction (FGR). METHODS: Two hundred seventy-four low-risk women had serial fetal biometry at scheduled intervals. Growth velocity of the fetal abdominal area for each was calculated with 2-, 4-, and 6-week scan intervals in which the second measurement was the last scan before delivery. Fetal abdominal area velocity over a 4-week interval in the early third trimester also was included. Fetal growth restriction was defined as skinfold thickness under the tenth percentile, ponderal index under the 25th percentile, midarm circumference-to-occipitofrontal circumference ratio of under -1 standard deviation (SD). Test performance was expressed as likelihood ratios with 95% confidence intervals (CI). RESULTS: Fetal abdominal area velocity calculated over a 4-week interval predicted FGR with a likelihood ratio of 10.4 (95% CI 3.9, 26) for skinfold thickness; 9.5 (95% CI 4.6, 19) for ponderal index; and 4.7 (2.3, 8.4) for midarm circumference-to-occipitofrontal circumference ratio. Intermeasurement intervals of 6 weeks had a likelihood ratio of 8.5 (95% CI 4, 17) for skinfold thickness; 7.5 (95% CI 3.4, 16.1) for ponderal index; and 14 (6.7, 28) for midarm circumference-to-occipitofrontal circumference ratio. The likelihood ratios for the 2-week interval and the early third trimester 4-week interval were all less than 5. CONCLUSION: Four- and 6-week measurement intervals were useful for predicting infants with FGR and were superior to a 2-week interval. Fetal growth velocity is influenced by proximity of the last fetal measurement to date of delivery, which adversely affects clinical use of growth velocity for predicting FGR.     

Fetal abdominal circumference rather than fetal femur length/abdominal circumference ratio predicts fetal malnutrition in high risk pregnancies

The aim of this study was to compare the ability of abdominal circumference (AC) and fetal femur length/abdominal circumference ratio (FFL/AC) measured by ultrasound within a period of 2 weeks before birth to predict low birth weight percentile and neonatal signs related to fetal malnutrition. From longitudinal ultrasound measurements in 35 normal pregnancies reference data of AC and FFL was obtained. FFL/AC ratio was constant from 21 weeks until term (mean 20.9, SD 1.2) (figure 1). In 350 risk pregnancies AC standard deviation score (AC-SDS) correlated far better than FFL/AC ratio with the deviation of birth weight from normal (figure 3). Furthermore AC-SDS correlated better with ponderal index (PI) and skinfold thickness (ST) than did FFL/AC ratio. Using cut-off levels on AC-SDS and FFL/AC ratio, which selected about 30% of the population, the sensitivity of AC-SDS in predicting the infant being LGA was 81.8% versus 42.9% using FFL/AC ratio (table II). The prediction of the infant being SGA was not improved when the change in AC-SDS or FFL/AC over the last 6-8 weeks of pregnancy was considered. We conclude that AC-SDS correlates well with birth weight deviation and predicts the infant being SGA with a precision equal to the best results reported in the literature, and that FFL/AC ratio is unreliable even when GA is not known because of a high false positive rate.     

B超测量胎儿双肩径及其它参数的临床应用

目的 探讨Ｂ超测量胎儿各径线的临床价值。方法 将１００例单胎孕３７￣４１周的孕妇产前３天内的Ｂ超测胎儿双顶径、股骨长、腹围、双肩径与生后３天内的新生儿各径线值比较,并进行其与新生儿体重的相关性的分析,应用双肩径预测巨大胎儿。结果 不同性别胎儿的各径线不同。Ｂ超测量胎儿各径线与生后测量值有良好的符合性,且与新生儿体重呈正相关。结论：双肩径为１１．０ｃｍ时巨大胎儿的诊断指数最好,对诊断巨大胎儿有帮助,     

Effectiveness of ultrasound determination of fetal abdominal circumference and fetal ponderal index in the diagnosis of asymmetrical growth retardation

A total of 310 unselected women attending an antenatal clinic was screened for growth retardation by ultrasound between 34 and 36 weeks gestation, by measuring the fetal abdominal circumference (AC) and femoral length (FL), from which the 'fetal ponderal index' (AC/FL) was calculated. Asymmetrical growth retardation in the newborn was assessed by Rohrer's ponderal index and the mid-arm/occipito-frontal circumference (MAC/OFC) ratio within 72 h of birth, a neonatal ponderal index or MAC/OFC ratio below the 10th centile being considered abnormal. The sensitivities of an AC below the 25th centile in identifying a birthweight, neonatal ponderal index or MAC/OFC ratio below the 10th centile were 86, 62 and 67% respectively, the specificities being 80, 78 and 76%. The sensitivities of a fetal ponderal index below the 25th centile in identifying a neonatal ponderal index or MAC/OFC ratio below the 10th centile were 52 and 47% respectively, the specificities being 77 and 77%. A possible reason for the poor performance of the fetal ponderal index is discussed.     

Effectiveness of ultrasound determination of fetal abdominal circumference and fetal ponderal index in the diagnosis of asymmetrical growth retardation

Summary. A total of 310 unselected women attending an antenatal clinic was screened for growth retardation by ultrasound between 34 and 36 weeks gestation, by measuring the fetal abdominal circumference (AC) and femoral length (FL), from which the 'fetal ponderal index' (AC/FL) was calculated. Asymmetrical growth retardation in the newborn was assessed by Rohrer's ponderal index and the mid-arm/ occipito-frontal circumference (MAC/OFC) ratio within 72 h of birth, a neonatal ponderal index or MAC/OFC ratio below the 10th centile being considered abnormal. The sensitivities of an AC below the 25th centile in identifying a birthweight, neonatal ponderal index or MAC/ OFC ratio below the 10th centile were 86, 62 and 67% respectively, the specificities being 80, 78 and 76%. The sensitivities of a fetal ponderal index below the 25th centile in identifying a neonatal ponderal index or MAC/OFC ratio below the 10th centile were 52 and 47% respectively, the specificities being 77 and 77%. A possible reason for the poor performance of the fetal ponderal index is discussed.     

Fetal abdominal subcutaneous tissue thickness measured by ultrasound at term is associated with birth weight and mode of delivery

PURPOSE: To determine if measurement of fetal abdominal subcutaneous tissue thickness (FASTT) at term can predict birth weight, mode of delivery and perinatal outcome. METHODS: A prospective study with 352 normal, singleton pregnancies in the vertex presentation examined with real-time ultrasound at 37-39 weeks' gestation. RESULTS: FASTT was positively correlated with birth weight (Pearson's, r = 0.784, p < 0.001). Fetuses with low FASTT were more likely to be delivered through normal vaginal delivery (7.8 +/- 0.1 mm), while higher FASTT was correlated with operative vaginal delivery (7.9 +/- 0.2 mm) and cesarean section (8.6 +/- 0.3 mm) (ANOVA, p = 0.034). In contrast, FASTT was not correlated with intrapartum CTG, labor duration and Apgar scores. CONCLUSIONS: In normal pregnancies, FASTT at term is positively associated with birth weight. With increasing FASTT the likelihood of operative vaginal and cesarean delivery increases. FASTT is not associated with perinatal outcome.     

Fetal ponderal index as an instrument for further classification of intra-uterine growth retardation.

Perinatal morbidity and mortality are still high in cases of intra-uterine growth retardation. Present screening methods select large risk groups and have a low positive predictive value. Instruments which could be used as indicators for those cases within the risk group needing close fetal monitoring would be valuable. The aim of this prospective study was to evaluate fetal ponderal index with respect to signs of fetal distress and neonatal outcome. By means of a risk scoring system, 73 pregnancies with increased risks of intra-uterine growth retardation were compared with 61 controls. By means of ultrasound, fetal weight was estimated and the fetal femur measured. The fetal ponderal index was calculated by dividing the estimated fetal weight in grams by the third power of the femur length. In the control group, 5/61 showed signs of distress and in the risk group, 43/73. The mean fetal ponderal index of the controls was 8.60 (SD 0.84) and in the risk group 7.72. The groups were compared with each other with respect to signs of distress. The fetuses showing signs of distress had a mean FePI of 7.45 (p less than 0.001). Those (30/73) in the risk group not showing signs of fetal distress had a mean value of 8.14 and differed significantly (p less than 0.001) from the distress group. Fetal ponderal index would seem to be a valuable adjunct for the differentiation of the more susceptible fetuses in an intra-uterine growth retardation risk group.     

Assessment of the usefulness of ultrasound screening in fetal ovarian cysts

OBJECTIVES: The aim of the study was to assess the usefulness of ultrasound in management and prognosis in fetal ovarian cysts. MATERIAL AND METHODS: The study included 38 fetuses with cyst in abdominal cavity, who, between 1995 and 2006, underwent an ultrasound examination in our unit at the Polish Mother's Memorial Hospital in Lodz, The Department for Diagnosis and Prevention of Birth Defects. RESULTS: In all 38 fetuses with cyst in abdominal cavity we have diagnosed 27 (74%) cases of ovarian cyst. In 14 (74%) fetuses cysts regressed spontaneously, including all cysts < or = 40mm (n = 7). In 3 cases with cysts > 40mm needle aspiration has been successfully performed, without any further complications. Surgical neonatal treatment has been performed in 5 cases in prenatal cysts > 40mm without prenatal aspiration. In 3 cases cysts > 40mm regressed spontaneously. Ovarian cysts in 22 (87%) cases were an isolated malformation; in 5 (19%) cases other malformations were present CONCLUSIONS: 1. Fetal ovarian cysts < or = 40mm required only ultrasound assessment and, in majority of cases, revealed the tendency to spontaneous regression. 2. Cysts > 40mm in maximal diameter have signaled complications more often and required surgical procedure after birth. 3. In utero, aspiration of fetal ovarian cyst > 40mm may lead to cyst regression, making the surgery after birth unnecessary.     

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)     

The ponderal index in triplets: I. Relationship to small for gestational age neonates

The aim of the study was to examine the ponderal index in small for gestational age (SGA) triplets. Prospectively collected data from a cohort of triplets born at 28 to 37 weeks were analyzed. A low neonatal ponderal index (birth weight/[length]3) was defined as less than 1 SD below the mean (2.0), and SGA was considered as birth weight below the 10th percentile by triplet standards. We studied 2181 sets of triplets. Triplets delivered at < or = 33 weeks have a lower mean ponderal index compared with those delivered at > 33 weeks. About 70% of SGA triplets do not have a low ponderal index, whereas 79.2% of infants with a low ponderal index are not SGA by triplet standards. Both the frequency of a low ponderal index and the frequency of infants with a low ponderal index who are not SGA decrease with increasing gestational age. We conclude that the majority of triplets with a low ponderal index might not be considered growth restricted, supporting the concept that reduced fetal weight of triplets is more likely a physiological rather than a pathological phenomenon.     

Maternal serum ferritin and fetal growth

OBJECTIVE: To determine the relationship between maternal serum ferritin and concentrations and specific types of fetal growth restriction (FGR). METHODS: Serum ferritin concentrations were measured at approximately 25 and 36 weeks' gestation in 480 multiparas with singleton fetuses who participated in a study of risk factors for repeated FGR. Asymmetric FGR was defined by low birth weight for gestational age criteria and a ponderal index less than 2.32, and symmetric FGR was defined by the same birth weight for gestational age criteria and a ponderal index of at least 2.32. RESULTS: Among 480 infants, 370 were appropriate for gestational age (AGA), 58 had asymmetric FGR, and 52 had symmetric FGR. Higher ferritin concentrations were associated with black race, maternal age 25 years or older, and smoking. Mothers of asymmetric-FGR infants had higher mean ferritin levels than mothers of AGA infants at 25 weeks' (38.0 versus 20.2 microg/L, P < .01) and 36 weeks' gestation (21.0 versus 13.3 microg/L, P < .01), whereas mothers of symmetric-FGR infants had significantly lower ferritin levels at 36 weeks (8.3 microg/L). For mothers with serum ferritin levels of at least 26 microg/L (highest quartile at 25 weeks), the adjusted odds ratio (OR) for asymmetric-FGR infants was 3.4, 95% confidence interval (CI) 1.6, 7.2. There was a similar association between the highest quartile of serum ferritin at 36 weeks (at least 20 microg/L) and asymmetric FGR (adjusted OR 2.7, 95% CI 1.3, 5.8). Women with serum ferritin levels less than 3 microg/L (lowest quartile at 36 weeks) had an adjusted OR for symmetric-FGR infants of 2.2, 95% CI 1.01, 4.6. CONCLUSION: High maternal serum ferritin levels are associated with asymmetric FGR, whereas low serum ferritin levels are associated with symmetric FGR.     

Value of fetal ponderal index in predicting growth retardation

Fetal ponderal indexes were calculated by ultrasound examination and compared with the neonatal ponderal indexes in 113 pregnancies. The relationship between the fetal and neonatal ponderal indexes throughout gestation is described. The fetal ponderal index also was evaluated as a predictor of intrauterine growth retardation (IUGR) and was found to have sensitivity and specificity of 76.9 and 82%, respectively. These data suggest that the fetal ponderal index could be used to rule out the diagnosis of IUGR with reasonable accuracy (negative predictive value 96.4%).     

Recent Advances in the Use of Doppler Waveform Indices in the Antenatal Assessment of Intrauterine Growth Retardation

Summary: Doppler ultrasound has been advocated as a useful tool to evaluate pregnancies with intrauterine growth retardation (IUGR). However, many previous studies have used smallness for gestational age (SGA) at birth to define IUGR. The ability of Doppler ultrasound to predict SGA, neonatal morphometric indices of wasting such as a low ponderal index, and perinatal morbidity is reviewed. Doppler assessment of the umbilical and uteroplacental vasculatures were inferior to ultrasound measurements of fetal size in the prediction of SGA. In low risk fetuses, umbilical artery waveform indices were of limited value in the prediction of neonatal morphometric indices of wasting. Within a group of high risk fetuses, Doppler assessment of the umbilical artery and, in particular, the middle cerebral and aortic vessels, were useful in predicting fetuses with neonatal wasting. Similar findings were noted in the prediction of perinatal morbidity. The review confirms the usefulness of umbilical artery Doppler waveform indices in the antenatal assessment of IUGR. Whilst preliminary studies appear to suggest that Doppler waveform indices of the middle cerebral and aortic vessels may confer an additional advantage in the antenatal assessment of IUGR, randomized controlled trials evaluating their effect on perinatal outcome and studies on the reproducibility of these indices need to be carried out before their widespread introduction into obstetric practice.     

Doppler predictors of adverse neonatal outcome in the growth restricted fetus at 34 weeks' gestation or beyond

OBJECTIVE: The study was undertaken to assess whether prenatal Doppler variables can identify cases of fetal growth restriction (FGR) approaching term who are at risk for adverse neonatal outcome. STUDY DESIGN: From a cohort of FGR cases delivered at >or=34 weeks, fetal biometry and pulsatility indices (PI) of fetal arteries obtained less than 2 weeks before delivery were related to adverse neonatal outcome, defined as admission to the neonatal intensive care unit (NICU) for indications other than low birth weight alone. RESULTS: Stepwise regression analysis showed that after controlling for gestational age at delivery and fetal biometry, only the last umbilical artery (UA) PI percentile was significantly predictive of adverse neonatal outcome (odds ratio=1.02, 95% CI 1.01-1.03, P=.02). Receiver operating characteristic curve analysis identified a UA PI at the 65th percentile as optimal predictor of adverse neonatal outcome (sensitivity=60%, false-positive rate=30%). CONCLUSION: In FGR cases delivered at >/=34 weeks' gestation, Doppler PI at the UA independently predicts the likelihood of admission to the NICU for reasons other than low birth weight alone.     

孕20～24周临床联合超声预测胎儿出生体重的研究

目的:探讨影响孕20～24周胎儿出生体重的相关因素,构建孕20～24周预测胎儿出生体重的公式。方法:前瞻性研究2011年3月至5月在江苏省产前诊断中心超声室行中期(孕龄20～24周)胎儿结构筛查的单胎孕妇235例,孕前月经规则。根据身份证记录孕妇年龄,询问并记录孕前体重;测量孕妇身高及超声检查时的体重,根据末次月经确定孕龄;超声测量胎儿生物学参数:双顶径、头围、腹围、股骨及肱骨;随访孕妇分娩前体重、新生儿出生体重、胎龄及性别。采用逐步多元回归分析方法,通过173例建立中孕期预估胎儿出生体重的公式。用已建立的回归方程前瞻性预测62例孕妇的胎儿出生体重,并验证其准确性。结果:单指标:孕妇孕前体重及BMI、行超声检查时体重及BMI、分娩前体重及BMI、中孕时胎儿腹围、股骨长、肱骨长、胎龄以及超声检查至分娩时的时间间隔与出生体重均有一定关系(P≤0.10),故纳入上述参数逐步多元回归分析,得出预测胎儿出生时体重的方程:预测的出生体重=-501.14+12.52×时间间隔+34.19×孕妇行超声检查时的BMI+8.61×超声检查时测量的胎儿腹围。通过验证,绝对误差值≤250g者56例,占90.32%,相对误差在10%以下者57例,占91.93%。结论:孕妇中孕期BMI、胎儿腹围超声测量值以及该次超声检查至分娩的间隔时间是预测胎儿出生体重的主要参数。     

Intrauterine weight index in fetal growth retardation]

The intra uterine ponderal index (IPI) estimated by ultrasound examination (US) in 79 patients with intrauterine growth retardation (IUGR) is presented. The IPI was calculated using the following formula: [formula: see text] 13.2 (DFO) + 22 (DAT) + 8.9 (DAP) - 48.4 (LF) - 7469.1, and ETF = 0.55 (LF) + 8.66. Correlation indexes (r) of EPF, ETF and IPI with neonatal weight, length and ponderal index were 0.92, 0.87 and 0.51 (p < 0.001). The IPI revealed a gradual increase with respect to gestational age ranging from 1.63 to 3.08. The p 10 of the IPI was 1.96 for pregnancies of 30 to 34 weeks and 2.35 for pregnancies of 35 to 39 weeks. Those cases of IUGR with IPI < p 10 (n = 7) had a higher incidence of cesarean section (86% vs 30%, p < 0.01), intrapartum fetal distress (71% vs 11%, p < 0.01), Apgar score of < 7 at 5' (29% vs 1.4%, p < 0.05), PBF < 5 points (43% vs 4.7%, p < 0.01), and moderate or severe neonatal morbidity (57% vs 21%, p < 0.05) than those with IPI > or = p 10 (n = 72). No difference were found with respect to the presence of antepartum meconium (29% vs 6%, p = 0.09). In conclusion, ultrasonographic estimation of the IPI is another element of the examination that can help in the diagnosis of fetal condition in cases of IUGR, permitting to distinguish those fetuses that, having and estimated weight below the tenth percentile in a growth curve, are in higher perinatal risk.