IUGR

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IUGR

WorkUp
Complete U/S Anatomic Survey (Fetal Echo is any question of Cardiac Abnormality)
Early Screen vs Cell Free DNA
Fetal Genetic Studies IF (early, severe <5%, Symmetric IUGR)
CMV, Toxoplasmosis, Rubella, Varicella


Antenatal Surveillance
Serial Growth U/S q3-4 weeks
Single course of Corticosteroids for <34 weeks.
If imminent delivery <32 weeks, Magnesium Sulfate
BPP
Weekly if mild & No associated comorbidities
Twice Weekly if Severe / Oligohydramnios / Pre-E / Decelerating Growth/Increased UA Doppler Index
Daily if Absent / Reversed or Absent EDF.


Doppler Velocimetry q2 weeks if >5% and no oligo / good growth
Normal EDF - reassuring - q2 weeks repeat, Consider term delivery, but not after 40 weeks.
Present but Decreased - q1 week repeat, 2x weekly BPPs. Deliver @ 37weeks
Absent - >34 weeks, delivery. <34 weeks, get a daily BPP & deliver if becomes abnormal
Reveresd EDF & >32 weeks - Consider delivery, >32 weeks, get a daily BPP & deliver if becomes abnormal.


When to Consider Delivery
(Most worrisome outcomes <3%)
38 0/7-39 6/7: isolated fetal growth restriction
34 0/7-37 6/7: IUGR with additional indication
oligohydroaminio
abnormal umbilical doppler
maternal risk factors / co-morbidities
References
utdol.com Fetal Growth Restriction 2016.
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