1. Fetal growth restriction
Frequency
In world : 10 %
In Iran : %
In Isfahan : ??? (5000 / year )

2. FIRST CASE
27years G2 l1 GA : 28w 2d (by LMP) Fundal height : 24 cm

3. History Past medical history : no problem Family history : no problem
Social history : secondhand smoker
Obstetrical history : down risk is low. Anomaly scan is normal .
She has a son 5 years that is healthy. His birth weight has been 2100gr at term.
Physical exam : normal .
BMI=18.5

4. Sonography from three days ago
Presentation :Cephalic
Placenta : Anterior
HC :232mm weeks ,1days
AC :218mm weeks,2days <10%
FL :49mm weeks
EFW :920 gr <10%
AFI : Normal

5. Second case 40y , G3L2(c/s) / GA = 35weeks 1days (LMP)
GA= 33weeks ,1 day( US 8 weeks )
FH : 30 cm
PMH : no problem
OBH : down screening =low risk ,anomaly scan=normal
Ultrasonography:
HC : mm weeks
AC : mm weeks , 2 days < 3 %
FL : mm weeks
EFW : 1332 gr < 3 %
AFI : mm

6. US Doppler MCA PI : 1.27 < 5 % Um.A EDF : absent
Uterine A. PI : 1.19

7. SGA vs. FGR
Symmetrical FGR vs. Asymmetrical FGR
Early FGR vs. Late FGR

9. All women should be assessed for risk factors for a SGA fetus to identify those who require increased surveillance.

10. Minor risk factor Maternal age > 35 years Null parity BMI <20
Smoker 1-10 cigarettes per day
Pregnancy interval < 6 months
Pregnancy interval >60 months
Past history from preeclampsia
IVF singleton
Low fruit intake pre–pregnancy

11. Major risk factor Maternal age > 40 years Daily vigorous exercise
Previous SGA baby
Smoker ≥ 11 cigarettes per day
Previous stillbirth
Maternal SGA
Paternal SGA

12. Major risk factor Preeclampsia Maternal Medical disease (APS)
Heavy bleeding similar to mense
Echogenic bowel
Low maternal weight
Low PAPP-A

13. Women who have a major risk factor (Odds Ratio >2
Women who have a major risk factor (Odds Ratio >2.0) should be referred for serial ultrasound .
Measurement of fetal size and assessment of wellbeing with umbilical artery Doppler from 26–28weeks of pregnancy .

14. Women who have three or more minor risk factors should be referred for uterine artery Doppler at 20–24 weeks of gestation .

15. Women with an abnormal uterine artery Doppler at 20–24 weeks (PI>95%)
and/or notching should be referred for serial ultrasound measurement of fetal size and assessment of wellbeing with umbilical artery Doppler commencing at 26–28 weeks of pregnancy.

16. Women with a normal uterine artery Doppler do not require serial measurement of fetal size and serial assessment of wellbeing with umbilical artery Doppler unless they develop specific pregnancy complications, for example antepartum hemorrhage or hypertension.
They should be offered a scan for fetal size and umbilical artery Doppler during the third trimester.

17. Serial ultrasound measurement of fetal size and assessment of wellbeing with umbilical artery Doppler should be offered in cases of fetal echogenic bowel.

31. Timing delivery
Abnormal DV(A/R a wave) or umbilical vein(pulsetile) with every GA .
Umbilical artery reverse EDV until weeks
Umbilical artery absent EDV until weeks
Umbilical artery high RI until weeks
Constitutional IUGR : weeks

32. Intervention
SGA and 35+6 weeks before delivery : antenatal corticosteroids
Biophysical profile should not be used for fetal surveillance in preterm SGA fetuses.
smoking cessation.

33. Indication of C/S Fetal acidemia Spontaneous late deceleration
Absent /reverse umbilical artery EDV