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Fetal Growth Restriction
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Juliana Gevaerd Martins, Alfred Abuhamad
Fetal growth restriction (FGR) is defined as the inability of the fetus to achieve its growth potential. FGR is a complex and multifactorial disorder resulting from maternal, fetal and placental conditions (Table 47.1) [1]. Placental insufficiency is the most common cause of FGR (30–40% of all cases) followed by chromosomal disorders and congenital malformations (20% of all cases) [2, 3].
Ultrasound
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
L. M. Porche, S. P. Chauhan, A. Abuhamad
FGR is defined as sonographically estimated fetal weight or abdominal circumference of less than the 10th percentile for gestational age. Recent guidelines recommend a diagnosis of severe FGR as estimated fetal weight of less than the third percentile for gestational age. Population-based fetal weight formula, such as the Hadlock formula, is recommended for use. FGR can be categorized as early or late onset. Early-onset FGR is diagnosed prior to 32+0 weeks’ gestation. Late-onset FGR is diagnosed after 32+0 weeks’ gestation. Detailed anatomic survey should be completed and genetic screening confirmed. Diagnostic amniocentesis with chromosomal microarray should be offered if FGR and fetal anomaly or polyhydramnios is detected regardless of the age at diagnosis. Suggested ultrasound follow-up, antenatal surveillance, and delivery guidelines can be found in the SMFM consult series on this topic [31] (see Chap. 47 in Maternal-Fetal Evidenced Based Guidelines).
Fetal growth restriction
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Daniel L. Jackson, M. Y. Divon, Hung N. Winn
FGR can be manifest by a variety of combinations of decreased fetal weight, body length, HC, AC, and soft tissue mass. Ultrasound is the only direct method available for assessing fetal size. It also provides for an assessment of factors associated with FGR such as fetal anomalies, oligohydramnios, and increased placental impedance. A thorough evaluation should include a detailed study of fetal, umbilical, and placental structural anomalies as well as measurements of the BPD, HC, AC, femur length (FL), and a semiquantitative assessment of amniotic fluid volume in the form of the amniotic fluid index (AFI). Morphometric ratios such as the HC:AC and FL:AC as well as a sonographic estimate of fetal weight can then be derived from these measurements. Umbilical artery (UA) Doppler velocity studies provide data regarding placental impedance to blood flow and may be constructive in patients who are at increased risk for FGR.
Regulatory roles of non-coding RNAs and m6A modification in trophoblast functions and the occurrence of its related adverse pregnancy outcomes
Published in Critical Reviews in Toxicology, 2022
Wang Rong, Wan Shukun, Wang Xiaoqing, Huang Wenxin, Dai Mengyuan, Mi Chenyang, Huidong Zhang
PE is a hypertensive disorder of pregnancy and affects 2–8% of pregnancies worldwide (Rana et al. 2019). GDM is currently the most common medical complication of pregnancy, and the prevalence of undiagnosed hyperglycemia and even overt diabetes in young women is increasing in recent years (McIntyre et al. 2019). FGR, also known as intrauterine growth restriction, affects 5–10% of pregnancies and is the second most common cause of perinatal mortality (Nardozza et al. 2017). Miscarriage includes all pregnancy losses from conception to 24 weeks of pregnancy (Rai and Regan 2006). It is estimated that about 15–25% of pregnant women have miscarriage (Wilcox et al. 1988); and 1–3% of pregnant women experience RM (recurrent miscarriage), that is, two or more consecutive miscarriages (Practice Committee of the American Society for Reproductive Medicine 2012).
Cerebroplacental doppler ratio and perinatal outcome in late-onset foetal growth restriction
Published in Journal of Obstetrics and Gynaecology, 2022
Ozge Kahramanoglu, Oya Demirci, Mucize Eric Ozdemir, Agnese Maria Chiara Rapisarda, Munip Akalin, Ali Sahap Odacilar, Hayal Ismailov, Gizem Elif Dizdarogullari, Aydin Ocal
Foetal growth restriction (FGR) is a major obstetrical challenge associated with an increased risk of perinatal outcomes (Chiofalo et al. 2017; Conde-Agudelo et al. 2018). FGR, as well as other pregnancy complications such as preeclampsia, is believed to be caused mostly by chronic placental insufficieny (Lyall et al. 2013; Morales-Rosello et al. 2014; Morales-Rosello et al. 2015; Lagana et al. 2017; Lagana et al. 2018). Late-onset FGR is not necessarily caused by a placental disease, but mostly accompanies by an imbalance between foetal demands and placental supply, indicating a normal foetus with suboptimal placenta (Morales-Rosello et al. 2014; Morales-Rosello et al. 2015). There is no consensus on clinical management of FGR as there is no best way to monitor foetal well-being in these pregnancies (Cignini et al. 2016; Conde-Agudelo et al. 2018). Therefore, clinical practice varies all around the world (Savchev et al. 2014; Unterscheider et al. 2014). Umbilical artery (UA) Doppler is commonly used to establish the risk of adverse perinatal outcomes in FGR, as it is associated with a significant reduction in perinatal morbidity and mortality (Cignini et al. 2016; Alfirevic et al. 2017; Figueras et al. 2018). Besides, increased foetal blood flow (brain-sparing effect) may indicate hypoxia (Baschat et al. 2001).
Placental Pathologic Changes Associated with Fetal Growth Restriction and Consequent Neonatal Outcomes
Published in Fetal and Pediatric Pathology, 2021
Do Hwa Im, Young Nam Kim, Hwa Jin Cho, Yong Hee Park, Da Hyun Kim, Jung Mi Byun, Dae Hoon Jeong, Kyung Bok Lee, Moon Su Sung
Fetal growth restriction (FGR) is defined as the failure of the fetus to achieve its genetically determined growth potential and is generally indicated by fetal weight less than the 10th percentile of the neonate’s gestational age. This condition is associated with an increased risk of fetal death in utero as well as increased neonatal morbidity and mortality [1, 2]. Growth-restricted fetuses are more likely to exhibit cognitive delay during childhood and suffer from diseases such as obesity, type 2 diabetes mellitus, coronary artery disease and stroke during adulthood [3, 4]. Various factors, such as maternal, fetal, and placental conditions, may contribute to the development of FGR [5, 6], of which inadequate placental circulation has been reported to be the primary cause of abnormal fetal growth [7].