Fetal growth restriction
What is it?
Fetal or intrauterine growth restriction (FGR/IUGR) refers to the fetus who does not achieve the expected in utero growth potential due to genetic or environmental factors. This event occurs in about 3-10% of pregnancies with variations due to the associated risk factors. It is caused by different mechanisms related to fetal, placental, and maternal factors. Major risk factor of fetal growth restriction involve: genetic abnormalities, fetal infection, structural anomalies, multiple pregnancies, ischemic placental diseases, maternal genetic factors or chrnonic diseases such as chronic hypertensive disorders, kidney diseases, autoimmunity, malformations, etc), preeclampsia, medically assisted reproduction, teratogens, extremes of maternal age. Risk of chomosomal abnormalities and single gene disorders are rather rare in isolated forms with normal anatomy.
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.
Where do we treat it?
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