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Intrauterine Growth Restriction

Resnik, Robert MD

High-Risk Pregnancy Series: An Expert's View

Fetal intrauterine growth restriction presents a complex management problem for the clinician. The failure of a fetus to achieve its growth potential imparts a significantly increased risk of perinatal morbidity and mortality. Consequently, the obstetrician must recognize and accurately diagnose inadequate fetal growth and attempt to determine its cause. Growth aberrations, which are the result of intrinsic fetal factors such as aneuploidy and multifactorial congenital malformations, and fetal infection, carry a guarded prognosis. However, when intrauterine growth restriction is caused by placental abnormalities or maternal disease, the growth aberration is usually the consequence of inadequate substrates for fetal metabolism and, to a greater or lesser degree, decreased oxygen availability. Careful monitoring of fetal growth and well‐being, combined with appropriate timing and mode of delivery, can best ensure a favorable outcome. Ultrasound evaluation of fetal growth, behavior, and measurement of impedance to blood flow in fetal arterial and venous vessels form the cornerstone of evaluation of fetal condition and decision making.

The causes, methods of diagnosis, and up‐to‐date approach to the evaluation of fetal intrauterine growth restriction are delineated.

University of California, San Diego School of Medicine, La Jolla, California.

Address reprint requests to: Robert Resnik, MD, University of California, San Diego School of Medicine, 0621, 9500 Gilman Drive, La Jolla, CA 92093–0621; E‐mail: rresnik@ucsd.edu.

We would like to thank the following individuals who, in addition to members of our Editorial Board, will serve as referees for this series: Dwight P. Cruikshank, MD, Ronald S. Gibbs, MD, Gary D. V. Hankins, MD, Philip B. Mead, MD, Kenneth L. Noller, MD, Catherine Y. Spong, MD, and Edward E. Wallach, MD.

Received October 15, 2001. Received in revised form December 3, 2001. Accepted December 13, 2001.

© 2002 The American College of Obstetricians and Gynecologists