Fetal growth restriction - From observation to intervention

Research output: Contribution to journalReview articlepeer-review

Abstract

Fetal growth restriction (FGR) due to placental dysfunction has important short- and long-term impacts that may reach into adulthood. Early-onset FGR before 34 weeks? gestation shows a characteristic sequence of responses to placental dysfunction that evolves from the arterial circulation to the venous system and finally to biophysical abnormalities. In this form of FGR safe prolongation of pregnancy is a primary management goal, as gestational age at delivery, birth weight and iatrogenic premature delivery have an important impact on short-term outcome and neurodevelopment. Surveillance intervals should be adjusted based on umbilical artery and venous Doppler studies. Intervention thresholds need to be based on the balance of fetal vs. neonatal risks and therefore critically depend on gestational age. Late-onset FGR presents with subtle Doppler and biophysical abnormalities and therefore poses a diagnostic dilemma. Often unrecognized, term FGR contributes to a large proportion of adverse perinatal outcome. Monitoring intervals should be adjusted based on middle cerebral artery Doppler and fetal heart rate parameters. Delivery timing thresholds can be low. In both forms of FGR neurodevelopmental impacts of placental disease occur before clinical decisions regarding delivery timing arise. This places special emphasis on future preventative studies.

Original languageEnglish (US)
Pages (from-to)239-246
Number of pages8
JournalJournal of Perinatal Medicine
Volume38
Issue number3
DOIs
StatePublished - May 1 2010
Externally publishedYes

Keywords

  • Biophysical profile
  • Doppler
  • Ductus venosus
  • Early-onset fetal growth restriction
  • Late-onset fetal growth restriction
  • Mbilicalartery
  • Middle cerebral artery
  • Neurodevelopment

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

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