Growth Restriction
The first clinical sign of fetal growth restriction may be an abnormally low increase in serial fundal height measurements. When fundal height growth is inappropriate for gestational age, an ultrasound examination should be ordered to confirm or refute the diagnosis. Most important is evaluation of the fetal head and abdominal circumferences and their ratio, as well as femur length. Abdominal circumference measurements are the most reliable index of fetal size. Amniotic fluid volume assessment and a careful evaluation of fetal anatomy are also helpful in establishing the diagnosis. Doppler velocimetry of umbilical arteries shows a strong correlation between abnormal systolic-diastolic ratios, the diagnosis of fetal growth restriction, and adverse pregnancy outcome. In general, however, there are no methods that allow a confident diagnosis of fetal growth restriction antenatally.
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Once fetal growth restriction is suspected, the fetus must be considered at risk for intrauterine hypoxia and possibly death. In those fetuses, near-term prompt delivery is indicated; however, in those remote from term, fetal surveillance is recommended. In general, fetal testing is performed twice a week by use of the NST, CST, BPP, or umbilical artery velocimetry. Amniotic fluid volume assessment should also be performed. The absence of demonstrable fetal growth in association with mature fetal lungs suggests that delivery may be warranted. Furthermore, delivery may be indicated if the amniotic fluid volume is severely decreased. Subsequent newborn growth cannot be predicted, nor can subsequent neurologic and intellectual capabilities.
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