Screening Tools for Intrauterine Growth Restriction
TORCH screening is the most reasonable screening tool among the options listed for a baby with intrauterine growth restriction, as congenital infections are an established etiology that requires evaluation, particularly when IUGR is detected before 32 weeks or when other abnormalities are present.
Diagnostic Workup for IUGR
Primary Evaluation
Comprehensive anatomic ultrasound survey is the cornerstone of IUGR evaluation to identify structural anomalies, as approximately 10% of fetuses with growth restriction have congenital anomalies 1, 2.
Genetic testing with chromosomal microarray analysis should be offered when fetal growth restriction is detected with malformations or when unexplained isolated growth restriction is diagnosed before 32 weeks 2.
Role of Infection Screening (TORCH)
TORCH screening addresses infectious etiologies that are among the established causes of IUGR, including toxoplasmosis, rubella, cytomegalovirus, herpes simplex, and other congenital infections 3, 4.
Congenital infections represent one of the multiple maternal, placental, and fetal factors that contribute to IUGR as an end result 5.
While the evidence provided doesn't explicitly mandate TORCH screening in all IUGR cases, identifying underlying causes impacts both short-term management and long-term prognosis 3.
Why the Other Options Are Less Appropriate
Urinalysis is not a standard screening tool for IUGR evaluation. While maternal disease treatment is part of general management measures 6, urinalysis is not specifically recommended in the guidelines for IUGR workup.
Chest X-ray has no role in the routine evaluation of IUGR. It is not mentioned in any guideline recommendations for IUGR assessment 7, 1.
Essential Surveillance Components
Beyond initial screening, proper IUGR management requires:
Umbilical artery Doppler assessment is the primary surveillance tool, as its use significantly reduces perinatal deaths (RR 0.71) and guides delivery timing 1.
Serial ultrasound examinations every 2-4 weeks to monitor growth parameters and amniotic fluid 2.
Common Pitfalls to Avoid
Do not skip the comprehensive anatomic survey, as structural anomalies are present in 10% of IUGR cases and change management 2.
Do not fail to consider genetic testing, especially for early-onset or unexplained IUGR, as this impacts counseling and prognosis 2.
Although an underlying cause may not always be identifiable in up to 40% of cases, it remains important to consider all etiologic factors because identification impacts both management and prognosis 3, 4.