February 4, 2020
Intrauterine growth restriction occurs when the baby is less than the 10th percentile in growth, and if a mother has one baby with IUGR there is a 20% risk of reoccurrence. It is, therefore, vital that all physicians be well versed in the signs, symptoms and diagnostic markers for the condition, according to Dr. Elizabeth Lee, an obstetrics fellow at the College of Community Health Sciences. She also cares for patients at University Medical Center, which the College operates.
In the case presented at the first installment of the College’s Medical Grand Rounds of 2020, Lee diagnosed a severe case of IUGR in a 24-year-old female during her fourth pregnancy.
In cases of IUGR, a condition in which an unborn baby is smaller than it should be because it is not growing at a normal rate inside the womb, there is an increased risk of mortality, cognitive delay, adult disease and small-for-gestational-age complications. Patients presenting with IUGR must be monitored closely for increasing signs of fetal distress said Lee.
Screening techniques include measuring fundal height, but this is less accurate in obese patients and those with leiomyomas, or fibroids. Ultrasounds can measure biparietal diameter, head circumference, abdominal circumference and femur length, as well as the amniotic fluid index, umbilical artery dopplers and biophysical profile.
An umbilical artery doppler is shown to reduce the rate of perinatal death by 29% and can show if placental insufficiency is the cause, said Casey Shinholster, an ultrasound technician at UMC. It is often used in conjunction with other diagnosing techniques.
The umbilical artery doppler uses three elements: the systolic peak, the end-diastolic flow and the mean velocity. From those three data points, the resistance index, pulsatility index and systolic diastolic ratio can be found. Delivery can be managed using the American College of Obstetricians and Gynecologists guidelines, according to Lee.
The College’s Grand Rounds series, which provides Continuing Medical Education for physicians and other health professionals, is designed to help medical professionals and learners look at past cases and learn from the investigative process.