Accessible Requires Authentication Published by De Gruyter March 8, 2010

Fetal growth restriction – from observation to intervention

Ahmet Alexander Baschat
From the journal

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.


Corresponding author: Ahmet Alexander Baschat, MD Department of Obstetrics Gynecology and Reproductive Sciences University of Maryland 22 South Greene Street 6th floor Baltimore MD 21201 USA Tel.: +1 (410) 328 6475 Fax: +1 (410) 328 1669

Received: 2009-8-30
Accepted: 2009-12-7
Published Online: 2010-03-08
Published Online: 2010-03-8
Published in Print: 2010-05-01

©2010 by Walter de Gruyter Berlin New York