Donald School Journal of Ultrasound in Obstetrics and Gynecology

Register      Login

VOLUME 4 , ISSUE 3 ( July-September, 2010 ) > List of Articles


Ultrasound and Doppler Management of Intrauterine Growth Restriction

Francesc Figueras, Eva Meler, José M Carrera

Keywords : Intrauterine growth restriction,Fetal biometry,Ultrasonography,Doppler

Citation Information : Figueras F, Meler E, Carrera JM. Ultrasound and Doppler Management of Intrauterine Growth Restriction. Donald School J Ultrasound Obstet Gynecol 2010; 4 (3):259-274.

DOI: 10.5005/jp-journals-10009-1148

License: CC BY-NC 4.0

Published Online: 01-06-2011

Copyright Statement:  Copyright © 2010; The Author(s).


Review of present knowledge about fetal growth, and clinical and ultrasonography diagnosis of Intrauterine growth restriction by means of 2D and 3D. The review included the diagnosis of type of IUGR and the study of fetal deterioration (Chronic Tests and Acute Markers). Also the obstetrics management.

PDF Share
  1. Perinatal mortality and fetal growth restriction. Best Pract Res Clin Obstet Gynaecol 2004; 18(3):397-410.
  2. Cerebral palsy and intrauterine growth in single births: European collaborative study. Lancet 2003;362(9390): 1106-11.
  3. Sudden infant death syndrome and complications in other pregnancies. Lancet 2005;366(9503):2107-11.
  4. Fetal nutrition and adult disease. Am J Clin Nutr 2000;71(5 Suppl):1344S-52S.
  5. Small for gestational age is not a diagnosis. Ultrasound Obstet Gynecol Apr 1999;13(4): 225-28.
  6. Body proportionality of the small-for-date fetus: Is it related to aetiological factors? Early Hum Dev 1996;45(1-2):1-9.
  7. Relationship between the sonographic pattern of intrauterine growth restriction and acid-base status at the time of cordocentensis. Arch Gynecol Obstet 2001;264(4): 191-93.
  8. Comparison of associated high-risk factors and perinatal outcome between symmetric and asymmetric fetal intrauterine growth retardation. Am J Obstet Gynecol 1991;164(6 Pt 1):1535-41;discussion 41-42.
  9. Impact of intrauterine growth retardation and body proportionality on fetal and neonatal outcome. Pediatrics 1990; 86(5):707-13.
  10. Definitions, etiology and clinical implications. Ultrasound and Fetal Growth. The Parthenon Publish, Lodon 1999;17-34.
  11. Intrauterine growth retardation: Beyond birthweight criteria. Early Hum Dev 1983;8(3-4):189-93.
  12. Fetal growth retardation: Associated malformations and chromosomal abnormalities. Am J Obstet Gynecol 1993;168(2):547-55.
  13. First trimester maternal serum free human chorionic gonadotropin as a predictor of adverse pregnancy outcome. Fetal Diagn Ther 2002;17(6):352-56.
  14. Soluble endoglin and other circulating antiangiogenic factors in preeclampsia. N Engl J Med 2006;355(10):992-1005.
  15. Multicenter screening for pre-eclampsia and fetal growth restriction by transvaginal uterine artery Doppler at 23 weeks of gestation. Ultrasound Obstet Gynecol 2001;18(5):441-49.
  16. Screening for pre-eclampsia and fetal growth restriction by uterine artery Doppler at 11-14 weeks of gestation. Ultrasound Obstet Gynecol 2001;18(6):583-86.
  17. Does antenatal identification of smallfor- gestational age fetuses significantly improve their outcome? Ultrasound Obstet Gynecol 2005;25(3):258-64.
  18. Materrnal and Child Health Consortium. CESDI 8th Annual Report: Confidential Inquiry of Sitllbith and Deaths in Infancy, 2001.
  19. The Investigation and Management of The Small-for-Gestational Age Fetus. Geen-Top Guidelines 2002(Guideline No.31).
  20. Controlled trial of fundal height measurement plotted on customised antenatal growth charts. Br J Obstet Gynaecol 1999;106(4):309-17.
  21. Estimating the date of confinement: Ultrasonographic biometry versus certain menstrual dates. Am J Obstet Gynecol 1996;174(1 Pt 1):278-81.
  22. A critical evaluation of sonar “crown-rump length” measurements. Br J Obstet Gynaecol 1975;82(9):702-10.
  23. A comparative analysis of second-trimester ultrasound dating formulae in pregnancies conceived with artificial reproductive techniques. Ultrasound Obstet Gynecol 1996;8(6):397-402.
  24. Prediction of the small for gestational age infant: Which ultrasonic measurement is best? Obstet Gynecol 1992;80(6):1030-38.
  25. The impact of choice of reference charts and equations on the assesment of fetl biometry. Ultrasound Obstet Gynecol 2005;25:559-65.
  26. Validity of ultrasound estimation of fetal weight. Obstet Gynecol 2000;95(6 Pt 1):856-60.
  27. An evaluation of two equations for predicting fetal weight by ultrasound. Am J Obstet Gynecol 1982;142(1):47-54.
  28. Estimation of fetal weight with the use of head, body, and femur measurements: A prospective study. Am J Obstet Gynecol 1985;151(3):333-37.
  29. Accuracy of sonographic estimates of fetal weight in very small infants. Ultrasound Obstet Gynecol 1999;13(2):99-102.
  30. Identification of fetal growth retardation: Comparison of Doppler waveform indices and serial ultrasound measurements of abdominal circumference and fetal weight. Obstet Gynecol 1993; 82(2):230-36.
  31. Prediction of perinatal morbidity at term in small fetuses: Comparison of fetal growth and Doppler ultrasound. Br J Obstet Gynaecol 1994;101(5):422-27.
  32. Design and analysis of longitudinal studies of fetal size. Ultrasound Obstet Gynecol 1995;6(5): 307-12.
  33. Biometric assesment. Best practice and Research Clinical Obstetrics and Gynecology 2009;23:819-31.
  34. Standards for ultrasound fetal growth velocity. Br J Obstet Gynaecol 1996;103(1):60-69.
  35. Screening for fetal growth restriction: A mathematical model of the effect of time interval and ultrasound error. Obstet Gynecol 1998;92(6):908-12.
  36. Z-velocity in screening for intrauterine growth restriction. Ultrasound Obstet Gynecol 2005;26(6):634-38.
  37. Mathematic modeling of fetal growth: Development of individual growth curve standards. Obstet Gynecol 1986;68(2):156-61.
  38. Fetal growth: A comparison of growth curves with mathematical modeling. J Ultrasound Med 1993;12(5):271-74.
  39. Charts of fetal size: 1. Methodology. Br J Obstet Gynaecol 1994;101(1):29-34.
  40. References intervals for fetal biometrical parameters. Eur J Obstet Gynecol Reprod Biol 2002;105(1):25-30.
  41. Birth weight from pregnancies dated by ultrasonography in a multicultural British population. Bmj 1993;307(6904):588-91.
  42. Prematurity and fetal growth restriction. Early Hum Dev 2005;81(1):43-49.
  43. Customized fetal growth standards: Rationale and clinical application. Semin Perinatol 2004;28(1):33-40.
  44. Customized fetal weight limits for antenatal detection of fetal growth restriction. Ultrasound Obstet Gynecol 2000;15(1):36-40.
  45. Customized birthweight centiles predict SGA pregnancies with perinatal morbidity. BJOG 2005;112(8):1026-33.
  46. Perinatal outcome in SGA births defined by customised versus population-based birthweight standards. BJOG 2001;108(8): 830-34.
  47. Customized versus population-based birth weight standards for identifying growth restricted infants: a French multicenter study. Am J Obstet Gynecol 2006; 194(4):1042-49.
  48. Adjustment of birth weight standards for maternal and infant characteristics improves the prediction of outcome in the small-for-gestationalage infant. Am J Obstet Gynecol 1996;175(3 Pt 1):544-47.
  49. Fetal upper arm volume in predicting intrauterine growth restriction: A three-dimensional ultrasound study. Ultrasound Med Biol 2005; 31(11):1435-39.
  50. The efficacy assessment of thigh volume in predicting intrauterine fetal growth restriction by three-dimensional ultrasound. Ultrasound Med Biol 2005;31(7):883-87.
  51. The assessment of normal fetal liver volume by three-dimensional ultrasound. Ultrasound Med Biol 2003;29(8):1123-29.
  52. Umbilical artery Doppler revisited: Pathophysiology of changes in intrauterine growth restriction revealed. Ultrasound Obstet Gynecol 2003;21(5):419-22.
  53. Absence of end diastolic frequencies in umbilical artery: A sign of fetal hypoxia and acidosis. Bmj 1988;297(6655):1026-27.
  54. Amino acids, glucose and lactate concentrations in umbilical cord blood in relation to umbilical artery flow patterns. Eur J Obstet Gynecol Reprod Biol 1994;57(2):117-22.
  55. Fetal umbilical artery velocity waveforms and subsequent neonatal outcome. Br J Obstet Gynaecol 1991;98(4):378-84.
  56. Comprehensive fetal assessment with three ultrasonographic characteristics. Am J Obstet Gynecol 1992;166(5):1486-95.
  57. Is intrauterine growth retardation with normal umbilical artery blood flow a benign condition? Bmj 1990;300(6731):1044-45.
  58. Is it time to reassess the risk for the growth-retarded fetus with normal Doppler velocimetry of the umbilical artery? Am J Obstet Gynecol 1994;170(6):1734-41; discussion 41-43.
  59. Intrauterine growth retardation: Prediction of perinatal distress by Doppler ultrasound. Lancet 1987;2(8556):415-18.
  60. An abnormal umbilical artery waveform: A strong and independent predictor of adverse perinatal outcome in patients with preeclampsia. Am J Obstet Gynecol 1994;171(3):713-21.
  61. Umbilical artery Doppler studies in small for gestational age babies reflect disease severity. Bjog 2000;107(7):916-25.
  62. A pilot randomized controlled trial of two regimens of fetal surveillance for small-for-gestational-age fetuses with normal results of umbilical artery Doppler velocimetry. Am J Obstet Gynecol 2000;182(1 Pt 1):81-86.
  63. Fetal growth velocity: A cautionary tale. Lancet 1999;353(9163):1460.
  64. Small for gestational age is not a diagnosis. Ultrasound Obstet Gynecol 1999;13(4): 225-28.
  65. Small-for-gestational-age fetuses with normal umbilical artery Doppler have suboptimal perinatal and neurodevelopmental outcome. Eur J Obstet Gynecol Reprod Biol. Jan 2008;136(1):34-38.
  66. Neurodevelopmental Outcome of Children With Intrauterine Growth Retardation: A Longitudinal, 10-Year Prospective Study. J Child Neurol 2007;22:580.
  67. Assessment of the fetal PO2 changes by cerebral and umbilical Doppler on lamb fetuses during acute hypoxia. Ultrasound Med Biol 1995;21(7):861-70.
  68. Accuracy of the middle-cerebral-to-umbilical-artery resistance index ratio in the prediction of neonatal outcome in patients at high-risk for fetal and neonatal complications. Am J Obstet Gynecol 1994;171(6):1541-45.
  69. The Doppler cerebroplacental ratio and perinatal outcome in intrauterine growth restriction. Am J Obstet Gynecol 1999;180(3 Pt 1):750.
  70. Cerebral-umbilical Doppler ratio as a predictor of adverse perinatal outcome. Obstet Gynecol 1992;79(3):416-20.
  71. The discrepancy between maturation of visual-evoked potentials and cognitive outcome at five years in very preterm infants with and without hemodynamic signs of fetal brain-sparing. Pediatrics 2000;105(2):385-91.
  72. Visual function at 11 years of age in preterm-born children with and without fetal brain sparing. Pediatrics 2007;119(6):e1342-e1350.
  73. Middle cerebral to umbilical artery Doppler ratio in post-date pregnancies. Obstet Gynecol 1994;84(5):856-60.
  74. Middle cerebral artery to umbilical artery resistance index ratio in the prediction of neonatal outcome. Int J Gynaecol Obstet 2000;71(2):119-25.
  75. Cerebroplacental Doppler ratio and adverse perinatal outcomes in intrauterine growth restriction: Evaluating the impact of using gestational age-specific reference values. J Ultrasound Med 2005;24(9):1223-28.
  76. Histomorphology of the placenta and the placental bed of growth restricted foetuses and correlation with the Doppler velocimetries of the uterine and umbilical arteries. Placenta 2003;24(5):510-16.
  77. Uterine and fetal cerebral Doppler predict the outcome of third-trimester small-for-gestational age fetuses with normal umbilical artery Doppler. Ultrasound Obstet Gynecol 2002;19(3):225-28.
  78. Prognostic value of uterine artery Doppler velocimetry in growth-restricted fetuses delivered near term. Am J Obstet Gynecol 2002;187(4):932-36.
  79. How useful is uterine artery Doppler flow velocimetry in the prediction of pre-eclampsia, intrauterine growth retardation and perinatal death? An overview. Bjog 2000;107(2):196-208.
  80. Effect of placental embolization on the umbilical arterial velocity waveform in fetal sheep. Am J Obstet Gynecol 1989; 161(4):1055-60.
  81. Doppler waveform pulsatility index and resistance, pressure and flow in the umbilical placental circulation: An investigation using a mathematical model. Ultrasound Med Biol 1990;16(5):449-58.
  82. Temporal sequence of abnormal Doppler changes in the peripheral and central circulatory systems of the severely growth-restricted fetus. Ultrasound Obstet Gynecol 2002;19(2):140-46.
  83. Qualitative venous Doppler flow waveform analysis in preterm intrauterine growth-restricted fetuses with ARED flow in the umbilical artery: Correlation with short-term outcome. Ultrasound Obstet Gynecol 2005;25(6):573-79.
  84. Doppler, cardiotocography, and biophysical profile changes in growth-restricted fetuses. Obstet Gynecol 2005;106(6): 1240-45.
  85. Absent end-diastolic velocity in umbilical artery: Risk of neonatal morbidity and brain damage. Am J Obstet Gynecol 1994;170(3):796-801.
  86. Infant wellbeing at 2 years of age in the Growth Restriction Intervention Trial (GRIT): Multicentred randomised controlled trial. Lancet 2004;364(9433):513-20.
  87. Monitoring of fetuses with intrauterine growth restriction: A longitudinal study. Ultrasound Obstet Gynecol 2001;18(6):564-70.
  88. The sequence of changes in Doppler and biophysical parameters as severe fetal growth restriction worsens. Ultrasound Obstet Gynecol 2001;18(6):571-77.
  89. Fetal cerebral blood flow redistribution in late gestation: Identification of compromise in small fetuses with normal umbilical artery Doppler. Ultrasound Obstet Gynecol 2000;15(3): 209-12.
  90. Use of umbilical-cerebral Doppler ratios in predicting fetal growth restriction in nearterm fetuses. Aust NZJ Obstet Gynaecol 2005;45(2):130-36.
  91. The discrepancy between maturation of visual-evoked potentials and cognitive outcome at five years in very preterm infants with and without hemodynamic signs of fetal brain-sparing. Pediatrics 2000;105(2):385-91.
  92. Perinatal outcome and amniotic fluid index in the antepartum and intrapartum periods: A meta-analysis. Am J Obstet Gynecol 1999;181(6):1473-78.
  93. Fetal myocardial responses to long-term hypoxemia. Comp Biochem Physiol A Mol Integr Physiol 1998; 119(3):669-74.
  94. Association of severe placental insufficiency and systemic venous pressure rise in the fetus with increased neonatal cardiac troponin T levels. Am J Obstet Gynecol 2000;183(3):726-31.
  95. Fetal venous, intracardiac, and arterial blood flow measurements in intrauterine growth retardation: Relationship with fetal blood gases. Am J Obstet Gynecol 1995;173(1):10-15.
  96. Relationship between monitoring parameters and perinatal outcome in severe, early intrauterine growth restriction. Ultrasound Obstet Gynecol 2004;23(2):119-25.
  97. Predictors of Neonatal Outcome in Early-Onset Placental Dysfunction. Obstet Gynecol Vol.109, No2, Part 1, February 2007.
  98. Venous Doppler in the prediction of acid-base status of growth-restricted fetuses with elevated placental blood flow resistance. Am J Obstet Gynecol 2004;191(1):277-84.
  99. Aortic isthmus Doppler velocimetry: Role in assessment of preterm fetal growth restriction. Prenat Diagn. 2010 May;30(5):395-401.
  100. Doppler assessment of the aortic isthmus and perinatal outcome in preterm fetuses with severe intrauterine growth restriction. Ultrasound Obstet Gynecol. Jan 2008;31(1):41-47.
  101. Contribution of the modified myocardial performance index and aortic isthmus blood flow index to refine prediction of mortality in preterm intrauterine growth restricted fetuses. Ultrasound Obstet Gynecol Oct 2009;34(4):430-36.
  102. Cardiotocography for antepartum fetal assessment. Cochrane Database Syst Rev 2000(2):CD001068.
  103. Comparison of visual and computerized interpretation of nonstress test results in a randomized controlled trial. Am J Obstet Gynecol 1999;181(5 Pt 1):1254-58.
  104. Antepartum fetal evaluation: Development of a fetal biophysical profile. Am J Obstet Gynecol 1980;136(6):787-95.
  105. Fetal assessment based on fetal biophysical profile scoring. VIII. The incidence of cerebral palsy in tested and untested perinates. Am J Obstet Gynecol 1998;178(4):696-706.
  106. Fetal biophysical profile score. VI. Correlation with antepartum umbilical venous fetal pH. Am J Obstet Gynecol 1993;169(4):755-63.
  107. The modified biophysical profile: Antepartum testing in the 1990s. Am J Obstet Gynecol 1996;174(3):812-17.
  108. Biophysical profile for fetal assessment in high-risk pregnancies. Cochrane Database Syst Rev 2000(2):CD000038.
  109. Doppler and biophysical assessment in growth restricted fetuses: Distribution of test results. Ultrasound Obstet Gynecol 2005.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.