Screening Tool for Intrauterine Growth Restriction
None of the options listed (TORCH screening, urine analysis, or chest x-ray) are reasonable first-line screening tools for a baby with intrauterine growth restriction—the appropriate initial evaluation requires a comprehensive anatomic ultrasound survey followed by umbilical artery Doppler assessment. 1, 2
Why the Listed Options Are Not Appropriate
TORCH Screening
- TORCH screening is not a routine first-line test for all IUGR cases 1
- While intrauterine infections can cause IUGR, they represent only one of many potential etiologies (maternal, placental, fetal, and genetic factors all contribute) 3, 4
- TORCH should be considered selectively based on clinical suspicion or specific ultrasound findings, not as universal screening 5
Urine Analysis and Chest X-Ray
- Neither urine analysis nor chest x-ray are part of the standard diagnostic workup for IUGR 1, 2
- These tests do not address the primary concerns in IUGR evaluation: structural anomalies, placental function, or fetal well-being 6, 1
What Should Actually Be Done
Primary Screening Tools
Comprehensive anatomic ultrasound survey is the cornerstone of IUGR evaluation:
- Identifies structural anomalies present in approximately 10% of IUGR fetuses 1
- Failure to perform this survey is a common pitfall that leads to missed diagnoses 1
Umbilical artery Doppler assessment is the primary surveillance tool:
- Significantly reduces perinatal deaths (RR 0.71) 1, 2
- Guides delivery timing and management decisions 6, 2
- Recommended by the American College of Obstetricians and Gynecologists as essential for IUGR management 2
Additional Evaluation
Genetic testing with chromosomal microarray analysis should be offered when:
- Fetal growth restriction is detected with malformations 1
- Unexplained isolated growth restriction is diagnosed before 32 weeks 1
- Failing to consider genetic testing is a common pitfall, especially for early-onset IUGR 1
Ongoing Surveillance
Serial ultrasound examinations every 2-4 weeks to monitor: