Intra-uterine growth restriction: investigation and management

Intra-uterine growth restriction(IUGR) is a common clinical diagnosis in obstetrics, although it is frequently not diagnosed until after delivery. There are many causes, and our understanding of the pathophysiology is limited. Individuals with a low birthweight have an increased risk of adult disease such as ischaemic heart disease, and the fetus and neonate have an increased risk of mortality and morbidity. Severe early-onset IUGR is uncommon, and presents difficult management decisions. Delivery is the only practical treatment option, and the timing of delivery must be aimed to maximize gestation whilst minimizing the risks of continued intra-uterine life. The investigation of the fetal circulation using Doppler has become more sophisticated, with greater attention being paid to the venous circulation, particularly the umbilical vein and ductus venosus.