Management of IUGR
Case in point
This patient was referred in at 30 weeks with a diagnosisof IUGR. We found the estimated fetal weight to be1000 g, which was well below the10thpercentile.
The TCD was appropriate for 30 weeks, the HC for 19weeks, and the AC for 28 weeks. Although morphologically normal appearing, the placenta was small. Therewas oligohydramnios with the largest vertical pocket being 1.5 cm. The umbilical arteries were slightly
discordantwith one having absent end diastolic flow and the otherhad a very low end diastolic component (S/D ratio of6.8). The MCA had evidence of brain sparing (S/D ratio of 3.2). The NST was reactive and the ductus had anormal waveform.We hospitalized her and initiated steroids to accelerate
fetal lung maturity. Over the next week both umbilicalarteries had absent
diastolic flow but nohint of reversedflow. Although the NSTs remained reactive, the velocityof the ductus flow during atrial contraction began tostray downward toward the baseline.We bailed out at 31 weeks 2 days, just as the patient was becoming overtly preeclamptic. The NST was
weakly reactive at that time.The fetus was born by cesarean section with a cordpH of 7.16, a base excess of 8, and Apgars of 8–9. Thebaby weighed 1200 g and did well enough in the nurseryto enter her first spelling Bee.