Fetal growth restriction
Which are the symptoms?
Pregnant patients with fetal anomalies or growth abnormalities do not refer specific symptomps. Occasionally reduced fetal movements, increased blood pressure or reduced simphisis-fundal lenght is reported. Generally, the clinical picture is detected at prenatal ultrasound. Fetal and neonatal symptomps include oligohydramnios, abnormal uterine artery, umbilical artery, middle cerebral artery Doppler studies.
- Abnormal uterine artery Doppler
- Reduced fetal biometry (below the 10th or 3rd centile)
How is it diagnosed?
Diagnosis of all fetal anomalies and growth disorders is based upon fetal ultrasound assessment. Diagnosis of fetal growth restriction can also be wrongly suspected in case of reduced fetal size with previous unreliable dating pf pregnancy (uncertain datas, no ultrasound performed in the first trimester of wrong measurement of the crown rump lenght). In the second trimester or thirs trimester the diagnosis can be carried out in most cases accurately due to reduced estimated fetal weight below the 3rd centile or below the 10th centile with an additional requirement (e.g. uterine artery pulsatility index above the 95th centile). When abnormality f fetal growth is detected fetal Doppler studies should be carried out and delivery timing is etablished as a function of fetal Doppler deterioration and gestationala age. The diagbnostic path includes detailed ultrasound scan, amniocentesis should be offered in early onset forms in order to exclude associated chomosomal or genetic conditions. Fetal cardiac scans, neurosonography or magnatic resonance imaging may be prosed in selected cases in order to describe subtle details of the neuroanatomy.
How is it treated?
There is no available prenatal treatment for fetal growth restriction. Several studies were carried out testing different potential candidate treatments and all resulted to be useless or even deleterious. The only available treatment for FGR is optimization of timing and mode of delivery with timely administration of steroids or magnesium sulphate to the mother to prevent respiratory distress syndrome and promote neuroprotection in case of prematurity.