Intrauterine growth restriction: Investigation and management

Intrauterine 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 maximise gestation while minimising the risks of continued intrauterine life. The investigation of the fetal circulation using Doppler ultrasonography has become more sophisticated, with greater attention being played to the venous circulation, particularly that unique to the fetus: the umbilical vein and ductus venosus.