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© 2007 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 26:1469-1477 • 0278-4297

Staging of Intrauterine Growth-Restricted Fetuses

Giancarlo Mari, MD, Farhan Hanif, MD, Kathrin Drennan, MD and Michael Kruger, MA

Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan USA.

Address correspondence to Giancarlo Mari, MD, Department of Obstetrics and Gynecology, Wayne State University, John R, Hutzel Hospital, 7 Brush, Detroit, MI 48201 USA. E-mail: gmari{at}hotmail.com

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.

Key Words: Doppler ultrasonography • fetal cardiovascular changes • idiopathic intrauterine growth restriction • intrauterine growth restriction • preeclampsia

Abbreviations: AFI, amniotic fluid index • ANOVA, analysis of variance • DV, ductus venosus • E/A, E wave/A wave • GRIT, Growth Restriction Intervention Trial • IUGR intrauterine growth restriction • MCA, middle cerebral artery • PI, pulsatility index • PSV, peak systolic velocity • RF, reversed flow • TR, tricuspid regurgitation • TV, tricuspid valve • UA, umbilical artery • UV, umbilical vein

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Copyright © 2007 by the American Institute of Ultrasound in Medicine.