Staging of intrauterine growth-restricted fetuses.
OBJECTIVE
The purpose of this study was to evaluate the value of cardiovascular, ultrasonographic, and clinical parameters for developing a staging classification of intrauterine growth-restricted (IUGR) fetuses delivered at 32 weeks or earlier.


METHODS
Intrauterine growth restriction was defined as the presence of an estimated fetal weight below the 10th percentile. Intrauterine growth-restricted fetuses were staged according to the following parameters, with the presence of any 1 parameter in a stage placing the fetus in that stage: stage I, an abnormal umbilical artery or middle cerebral artery pulsatility index; stage II, an abnormal middle cerebral artery peak systolic velocity, umbilical artery absent/reversed diastolic flow, umbilical vein pulsation and an abnormal ductus venosus pulsatility index; and stage III, reversed flow at the ductus venosus or reversed flow at the umbilical vein, an abnormal tricuspid E wave (early ventricular filling)/A wave (late ventricular filling) ratio, and tricuspid regurgitation. Each stage was divided into A (amniotic fluid index [AFI] <5 cm) and B (AFI >5 cm). The presence of maternal abnormalities was also reported.


RESULTS
Seventy-four IUGR fetuses delivered at 32 weeks or earlier were included. Gestational age at delivery was greater in stage I fetuses compared with the other stages. Birth weight decreased with advancing stages. Stage III fetuses had the lowest AFI. There was a direct correlation between the severity of staging and both perinatal mortality and mortality occurring between 20 weeks' gestation and before the neonates were discharged from the hospital (P < .05).


CONCLUSIONS
The staging system proposed here may allow comparison of outcome data for IUGR fetuses and may be valuable in determining more timely delivery for these high-risk fetuses.
Mari
Giancarlo
G
Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48201, USA. gmari@hotmail.com
Hanif
Farhan
F
Drennan
Kathrin
K
Kruger
Michael
M
D005260:Female; D005317:Fetal Growth Retardation / Q000145:classification* / Q000000981:diagnostic imaging*; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal / Q000379:methods*