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      Diagnosis and Management of Intrauterine Growth Retardation

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          Intrauterine growth retardation (IUGR) is associated with significant perinatal morbidity and mortality. This condition can be a sign of genetic disorders, fetal infection, uteroplacental insufficiency, or constitutionally small fetuses. Correct determination of gestational age is the first step in prenatal screening of growth-retarded fetuses. The discovery of a small-for-gestational age fetus necessitates fetal assessment for the evaluation of the etiology and prognosis, and for the determination of the optimal timing for delivery of these fetuses at risk of perinatal asphyxia. IUGR is more frequent in multiple-gestation pregnancies (23–34%) and will be discussed separately. There is no medical treatment for IUGR. Early aspirin treatment reduces the incidence of IUGR in a high-risk population but should not be used routinely in all pregnant women.

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          Clinical significance of absent or reversed end diastolic velocity waveforms in umbilical artery.

          Doppler ultrasound provides a non invasive method to assess fetal haemodynamics. We looked at the outcome of doppler velocimetry of the umbilical artery in three groups of pregnancies: those with positive end diastolic velocities (PED; n = 214), absent end diastolic velocities (AED; n = 178) and reversed end diastolic velocities (RED; n = 67). We collected our data from 9 European centers. Logistic regression showed that compared with pregnancies with hypertension only, pregnancies complicated by intra uterine growth retardation (IUGR) had a higher risk of developing absent or reversed end diastolic velocity waveforms (ARED) flow. ARED flow in the umbilical artery (odds ratio: OR = 3.1). Pregnancies complicated by both IUGR and hypertension had an even higher risk (OR = 7.4). Maternal age and smoking habits did not influence the risk of developing ARED flow. The overall perinatal mortality rate was 28%. Significantly more neonates in the ARED flow group needed admittance to the neonatal intensive care unit (PED group 60%, AED group 96%, RED group 98%). The OR for perinatal mortality in pregnancies complicated by AED flow was 4.0 and in RED flow was 10.6, compared with PED flow, even after adjustment for menstrual age. ARED flow in the umbilical artery did not influence the risk of respiratory distress syndrome or necrotising enterocolitis of the neonate, but ARED flow significantly influenced the risk of cerebral haemorrhage, anaemia, or hypoglycaemia. We advise that pregnancies complicated by IUGR and/or hypertension should be followed up with doppler velocimetry to trace utero-placental problems as early as possible. A caesarean section is recommended in all pregnancies complicated by ARED flow if the gestational age and predicted neonatal weight can be handled by the local neonatal intensive care unit.
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              Fetal oxygenation at cordocentesis, maternal smoking and childhood neuro-development


                Author and article information

                Horm Res Paediatr
                Hormone Research in Paediatrics
                S. Karger AG
                April 1998
                17 November 2004
                : 49
                : Suppl 2
                : 14-19
                Service de Gynécologie-Obstétrique, Hôpital Saint-Vincent-de-Paul, Paris, France
                53081 Horm Res 1998;49(suppl 2):14–19
                © 1998 S. Karger AG, Basel

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                Page count
                References: 53, Pages: 6


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