- 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
- Serial Growth U/S q3-4 weeks
- Single course of Corticosteroids for <34 weeks.
- If imminent delivery <32 weeks, Magnesium Sulfate
- 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
- abnormal umbilical doppler
- maternal risk factors / co-morbidities