title: [Delivery of the IUGR fetus].
abstract: OBJECTIVE
  The purpose of this paper is to review available data regarding the management of delivery in intra uterine growth retarded fetuses and try to get recommendations for clinical obstetrical practice.
  
  
  METHODS
  Bibliographic research performed by consulting PubMed database and recommendations from scientific societies with the following words: small for gestational age, intra-uterine growth restriction, fetal growth restriction, very low birth weight infants, as well as mode of delivery, induction of labor, cesarean section and operative delivery.
  
  
  RESULTS
  The diagnosis of severe IUGR justifies the orientation of the patient to a referral centre with all necessary resources for very low birth weight or premature infants Administration of corticosteroids for fetal maturation (before 34 WG) and a possible neuroprotective treatment by with magnesium sulphate (before 32-33 WG) should be discussed. Although elective caesarean section is common, there is no current evidence supporting the use of systematic cesarean section, especially when the woman is in labor. Induction of labor, even with unfavorable cervix is possible under continuous FHR monitoring, in favorable obstetric situations and in the absence of severe fetal hemodynamic disturbances. Instrumental delivery and routine episiotomy are not recommended. For caesarean section under spinal anesthesia, an adequate anesthetic management must ensure the maintenance of basal blood pressure.
  
  
  CONCLUSIONS
  Compared with appropriate for gestational age fetus, IUGR fetus is at increased risk of metabolic acidosis or perinatal asphyxia during delivery.
authors.affiliation: Pôle de gynécologie obstétrique, médecine fœtale, médecine et biologie de la reproduction, centre Olympe de Gouges, CHRU de Tours, 37044 Tours cedex, France; UMR Inserm U930, CNRS ERL 3106, université François-Rabelais de Tours, 37000 Tours, France. Electronic address: franck.perrotin@med.univ-tours.fr.
authors.forename: F
authors.initials: F
authors.lastname: Perrotin
authors.forename: E G
authors.initials: EG
authors.lastname: Simon
authors.forename: J
authors.initials: J
authors.lastname: Potin
authors.forename: M
authors.initials: M
authors.lastname: Laffon
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D036861:Delivery, Obstetric / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D005317:Fetal Growth Retardation / Q000628:therapy*; D005843:Geography; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D008278:Magnesium Sulfate / Q000627:therapeutic use; D011247:Pregnancy
chemical_list: D000305:Adrenal Cortex Hormones; D008278:Magnesium Sulfate
keywords: Anesthésie péridurale; Ballonnet intracervical; Caesarean section; Césarienne; Déclenchement du travail; Epidural anesthesia; Foley catheter balloon; Induction of labor; Intrauterine growth retardation (IUGR); Retard de croissance intra-utérin (RCIU)