IUGR — Diagnosis and Management

Which of the following Doppler parameters is the FIRST to become abnormal in intrauterine growth restriction?

A 28-year-old primigravida at 32 weeks gestation presents for routine antenatal care. Symphysis–fundal height is 28 cm (2 cm below expected). Ultrasound confirms estimated fetal weight at 5th percentile for gestational age with normal amniotic fluid volume and normal umbilical artery Doppler. Maternal blood pressure is 118/76 mmHg, urinalysis is normal. What is the most appropriate next step in management?

A 28-year-old primigravida from rural Maharashtra presents at 32 weeks of gestation with complaints of decreased fetal movements for 3 days. On examination, fundal height is 28 cm (less than expected for 32 weeks). Vital signs are stable. Doppler ultrasound shows abdominal circumference (AC) <10th centile, estimated fetal weight 1400 g (<10th centile for gestational age), and umbilical artery pulsatility index (PI) 1.8 (elevated). Amniotic fluid volume is normal. There is no evidence of fetal anomalies or maternal infection. What is the most appropriate next step in management?

A 35-year-old multigravida with hypertension is found to have a fetus with abdominal circumference <5th centile at 28 weeks gestation. Umbilical artery Doppler shows elevated pulsatility index (PI 2.1) with preserved end-diastolic flow. Which investigation is most appropriate to assess the severity of placental insufficiency and guide the timing of delivery?

A 32-year-old primigravida at 28 weeks of gestation presents with a fundal height 3 cm less than expected. Doppler ultrasound shows normal umbilical artery pulsatility index. Which is the most appropriate next investigation to differentiate between constitutional small-for-gestational-age and pathological IUGR?