Commentary

We need to pay closer attention to the 1st trimester


 

“CAN INTRAUTERINE GROWTH RESTRICTION BE PRESENT IN THE FIRST TRIMESTER?”
BY JOHN M. THORP JR, MD (EXAMINING THE EVIDENCE, JUNE)

Intrauterine growth restriction (IUGR) can be present in the first trimester, but we don’t talk about it because of a lack of documentation and our vague conception of IUGR. Some definitions need to be revised and updated, I believe, to reflect current knowledge and practice.

For instance: Loss of a fetus weighing less than 500 g is not always an abortion; it could represent severe IUGR in a fetus well past the 20-week mark. I have seen severe growth restriction in the first trimester on at least two occasions. Both cases were caused by cord problems—in one case, severe stricture; in the other, a tightened knot.

Close attention to first-trimester growth and development is possible now that technology has been developed, but does anyone (except the patient) care about the first trimester? ObGyn generalists consider a loss during the first trimester an abortion, and a maternal–fetal medicine (MFM) specialist will not even see a patient until she passes 20 weeks. In my opinion, the first 20 weeks are a dangerous time and should receive close attention from the MFM specialist to ensure survival of the fetus.

Stefan Semchyshyn, MD
Jonesborough, Tenn

Dr. Thorp responds: Clearly, we have much to learn

I appreciate Dr. Semchyshyn’s thoughtful comments. Caring and being able to change the outcome of a first-trimester problem are separate issues; an inability to alter pathophysiology in early pregnancy should not be confused with a lack of empathy. Ignorance clearly abounds about the biology of human pregnancy in the first trimester and, as Dr. Semchyshyn points out, we have much to learn.

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