Use of BW charts inappropriate for pregnant women residing in geographic areas at or near sea level. Lack of due consideration to important factors such as fetal length and growth potential The physician involved in antenatal recognition of IUGR should be well versed with current problematic and controversial issues in making such diagnoses. In the latter condition cephalic size is relatively spared in comparison to body weight, suggesting that the pathophysiologic process is both recent in onset and potentially remediable. 12 By contrast, delayed onset of growth restriction (after organ cell number is complete) is believed to adversely affect only cell size, and result in asymmetric IUGR. 12Д«ecause hyperplasia normally ceases at some time during fetal life, an early insult is likely to retard cell division and possibly lead to symmetric reduction in organ size. Finally, hyperplasia ceases and growth continues by cellular hypertrophy alone.

12 This is followed by cell hypertrophy or increase in cell size. Winick has suggested that early in pregnancy fetal organ growth takes place first by cell hyperplasia or cell division. Maternal disease (cardiovascular, renal, autoimmune, metabolic) Maternal use of drugs (alcohol, narcotics, nicotine, dilantin, beta-adrenergic blockers, corticosteroids) No fetal pole or yolk sac is visible yet.ДЄlthough the etiology of IUGR remains idiopathic in approximately 50% of cases, a number of factors may adversely influence fetal growth, including:

7 As to perinatal morbidity, Gruenwald, 8 Naeye and Kelly, 9 Scott and Usher, 10 and Fitzhardinge and Steven 11 have all described the nature of immediate and long-term physical and neurologic sequelae of the SGA infant.ДЇig. 6 Usher and McLean also found a tenfold increase in perinatal mortality in infants whose birth weight (BW) fell below 2 SD of the mean for dates. Yerushalmy reported an eightfold increase in the perinatal mortality of the small-for-gestational-age (SGA) neonate. These figures indicate that ultrasound, like other tests used to assess biologic function, is more specific in predicting the unaffected fetus than it is sensitive in the diagnosis of IUGR (Fig. 2, 3, 4, 5 By comparison, a diagnosis of altered fetal growth, using a combination of various sonographic parameters, can either be excluded or verified in over 90% and 80% of cases, respectively. 1 This low yield is attributed to inaccurate assessment of dates and fetal weight relative to fundal height. Antenatal diagnosis of intrauterine growth restriction (IUGR) by clinical means is possible in approximately one third of such pregnancies.

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