Management of pregnancies with suspected intrauterine growth retardation in Sweden - Results of a questionnaire

Background. Diagnosis and management of intrauterine growth retardation dur ing pregnancy remain a major challenge in obstetric care. The objective of this survey was to evaluate the routine clinical management of pregnancies with suspected intrauterine growth retardation at obstetric departments in Sweden. Methods. In 1997, a questionnaire was sent to all 59 obstetric departments in Sweden. Forty-two departments, caring for 83% of all deliveries in Swede n, replied. Four major topics were addressed: definition and diagnosis of i ntrauterine growth retardation; magnitude of the problem; clinical manageme nt; use of Doppler ultrasound in clinical decision-making. Results. Intrauterine growth retardation is diagnosed by a combination of s erial fundal height measurements and ultrasonic fetal biometry at 40 depart ments, two departments perform routine fetal biometry at 32 weeks. The diag nosis is most often made at 32-36 gestational weeks. Five departments use 1 .5 s.d. below the mean as cut-off point for diagnosis of small for gestatio nal age fetuses; 35 departments use mean - 2 s.d. and two departments mean 2.5 s.d. Intrauterine growth retardation is suspected in 1.6-6.3% pregnanci es. About 19% of patients with suspected intrauterine growth retardation ar e hospitalized. On average, 63% of ail small-for-gestational age babies are diagnosed prenatally. Thirty-nine out of 42 obstetric departments use form alized management protocols. All departments use cardiotocography, repeat u ltrasound scans and Doppler ultrasound for antenatal surveillance. Conclusions. In Swedish obstetric units, the diagnostic procedures and meth ods of fetal surveillance in pregnancies suspected of intrauterine growth r etardation are more or less uniform. Doppler examination of umbilical arter y is used at all responding departments and is considered a valuable asset in clinical decision-making.