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Screening and Triage of Intrauterine Growth Restriction (IUGR) on Stillbirths

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Reference
Imdad A, Yakoob MY, Siddiqui S, Bhutta ZA.   Screening and triage of intrauterine growth restriction (IUGR) in general population and high risk pregnancies: a systematic review with a focus on reduction of IUGR related stillbirths. BMC Public Health. 2011; 11 (Suppl 3): S1.

Background

  • Intrauterine growth restriction (IUGR) represents pathological inhibition of fetal growth and failure of the fetus to attain its growth potential (1).  There is a strong associate between stillbirth and fetal growth restriction (2). The etiology and risk factors for stillbirth and IUGR largely overlap (3, 4).  Both conditions are the result of complex pathology from a recognizable interaction among maternal conditions, placental dysfunction and hormonal regulation (2, 4).
  • To prevent complications associated with IUGR, one must detect the condition, institute appropriate surveillance to assess fetal well-being, and provide suitable intervention in case of fetal distress. (1, 5)

Intervention Effects

Fetal Movement Monitoring on Stillbirths

  • Insufficient evidence – no recommendation for or against routine use of fetal movement monitoring

Doppler Velocimetry of “High Risk” Pregnancies on Perinatal Mortality and Stillbirths

  • 29% reduction (RR: 0.71; 95% CI 0.52-0.98) in perinatal mortality – 16 studies (moderate quality)
  • Non-significant reduction (RR: 0.65; 95% CI 0.41-1.04) in stillbirths – 15 studies (low quality)
  • Recommend reduction in perinatal mortality (29%) as a proxy for reduction in stillbirths with conversion of its overall quality grade from “moderate” to “low” level.

Detection and Triage of IUGR on IUGR-related Stillbirths 

  • Due to insufficient availability of data, Delphi consensus process was convened.
  • The 31 expert panel concluded that a combination of maternal BMI screening, Symphysis-fundal height measurement, and targeted ultrasound followed by the appropriate management could potentially result in a:
    • 20% reduction in ante-partum stillbirth (IQR 10-37.5%)
    • 20% reduction in intra-partum stillbirth (IQR (5-30%)


Intervention Recommendation 

  • Surveillance of high risk pregnancies with Doppler velocimetry of umbilical and fetal arteries with appropriate timely obstetric intervention leads to a reduction of 29% (95% CI 2-48%) in stillbirths.
  • Combination of maternal BMI screening, Symphysis-fundal height measurement, and targeted ultrasound followed by the appropriate management could reduce both antepartum and intrapartum stillbirths by 20%.

References from Imdad Paper Cited Here

  1. Mandruzzato G, Antsaklis A, Botet F, Chervenak FA, Figueras F, Grunebaum A, Puerto B, Skupski D, Stanojevic M. Intrauterine restriction (IUGR) J Perinat Med. 2008;36(4):277–281.
  2. Bukowski R. Stillbirth and fetal growth restriction. Clin Obstet Gynecol. 2010;53(3):673–680. 
  3. Smith GC, Fretts RC. Stillbirth. Lancet. 2007;370(9600):1715–1725. 
  4. de Onis M, Blossner M, Villar J. Levels and patterns of intrauterine growth retardation in developing countries. Eur J Clin Nutr. 1998;52(Suppl 1):S5–15.
  5. Miller J, Turan S, Baschat AA. Fetal growth restriction. Semin Perinatol. 2008;32(4):274–280.

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