[Intrauterine growth retardation: prenatal surveillance and criteria for deciding on cesarean section]

Arch Pediatr. 2013 Sep;20(9):1046-52. doi: 10.1016/j.arcped.2013.06.014. Epub 2013 Jul 27.
[Article in French]

Abstract

The purpose of prenatal monitoring of a fetus with intra-uterine growth restriction (IUGR) is identifying very-high-risk cases, monitoring these fetuses closely, and making an appropriate decision for fetal extraction if their condition worsens. It should be emphasized that term and birth weight are important criteria in making a decision for extraction or non-extraction. Prognostic tests used for monitoring IUGR are the same as those used in all extraction decisions. This includes fetus growth and vitality estimation using ultrasound, fetal Doppler measurement, and fetal heart rate recording. There is no randomized trial giving priority to one criterion to decide whether or not it is necessary to extract a fetus with IUGR. Therefore, monitoring strategies and the extraction decision described herein are based in part on pathophysiology and uncontrolled series, and on the authors' experience. The question of timing the extraction using a single criterion is complex: what threshold should be used and how should it be integrated with other exams? How should one take into account the wide individual variability of the degradation sequence that can be observed with various tests at our disposal? Deliberately, there is no decision tree based on the result of different criteria in this chapter. We believe that fetal extraction decisions must be discussed case by case, collaboratively if time allows, and always after information and discussion involving the couple, the obstetrician, and the neonatologist.

MeSH terms

  • Birth Weight
  • Cerebral Arteries / diagnostic imaging
  • Cesarean Section*
  • Decision Making*
  • Female
  • Fetal Growth Retardation / surgery*
  • Heart Rate, Fetal
  • Humans
  • Infant, Newborn
  • Pregnancy
  • Ultrasonography, Prenatal
  • Umbilical Cord / diagnostic imaging