Detection of Fetal Growth Restriction with Preterm Severe Preeclampsia: Experience at Two Tertiary Centers
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Our objective was to determine if sonographic estimate of fetal weight (SEFW) can identify fetal growth restriction (FGR; birthweight < 10% for gestational age [GA]) among patients with preterm (28 to 32 weeks) severe preeclampsia (P SPE). At two centers, all singletons with reliable GA, P SPE, and SEFW within 3 weeks of birth were identified retrospectively. Intrauterine growth restriction was SEFW < or = 10% for GA. Likelihood ratio (LR) and guidelines by an Evidence-Based Medicine Working Group were used. At the two centers, IUGR was suspected in 20% (4 of 20) and 28% (5 of 18) of P SPE, and FGR was noted in 35% and 44%. At one center, suspected intrauterine growth restriction (IUGR) was associated with actual FGR in 50% of the cases and at center II, in 80%. The LR for IUGR to identify FGR was 3.0. We concluded that SEFW is not a useful diagnostic test in identifying FGR among patients with preterm SPE.Keywords:
Intrauterine growth restriction
Fetal growth
Growth restriction
Fetal weight
Intrauterine growth restriction (IUGR) is a unique and important issue for obstetricians. The acute neonatal consequences of IUGR are perinatal asphyxia and neonatal adaptive problems. However, the long-term outcomes of such neonates are less discussed because obstetricians usually only care for pregnant woman until delivery. The aim of this article is to review the sequelae, especially the long-term effects including the neurological, cardiovascular, renal, and metabolic effects of the growth restriction in an obstetrician's view.
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Intrauterine growth restriction
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Intrauterine growth restriction is a condition where the estimated fetal weight is less than the 10th percentile on ultrasound and the fetus has not attained its biologically determined growth potential because of a pathologic process. This review deals with the definitions of fetal growth restriction, the etiology associated with it, the types of fetal growth restriction and discusses how to differentiate between them. The various screening mechanisms available, the approach to a patient who is at risk for fetal growth restriction and whether they will benefit from any of the prophylactic measures available are also discussed.
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Fetal Growth Restriction (FGR) or Intrauterine Growth Restriction (IUGR) is one of the complications in pregnancy that is quite common, especially in developing countries, which is one of the contributors to neonatal mortality and morbidity rates. This literature review aims to provide related information, so that proper diagnosis and management can be carried out to reduce fetal morbidity and mortality rates. We searched from online databases and used review articles, research, guidelines from professional organizations, such as POGI from Indonesia, ACOG from the USA, and RCOG from the UK. Risk factor assessment and examination of fundal height can be the first steps in diagnosing IUGR. If suspicion is found, ultrasound (USG) and Doppler velocimetry can be performed. IUGR management mostly works in influencing the vasodilation of the placenta as the most common cause of IUGR events. Fetal Growth Restriction can be diagnosed immediately by screening for risk factors in pregnant women.
Intrauterine growth restriction
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Doppler ultrasound
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There is very extensive literature dealing with the definitions of the related terms intrauterine growth restriction (IUGR), fetal growth restriction (FGR), and small for gestational age (SGA). Numerous authors in many countries have published research findings attempting to define appropriate boundaries to classify growth in fetuses and infants. First, it should be emphasized that, conceptually, FGR and IUGR are not the same entity as "small for gestational age." For most authorities, a growth-restricted newborn is now defined as an infant who has not achieved its genetic growth potential in utero. This, of course, presupposes that one can determine growth potential, which, in reality, is not now possible. In many recent studies, authors have tended to use the term "small for gestational age," or "SGA," for a fetus who has failed to achieve a specific and arbitrary anthropometric or weight threshold by a specific gestational age. We are aware, however, that some SGA infants may be constitutionally small and may represent only the tail end of a normal distribution. For this article, we will focus on the definitions of SGA rather than on those for intrauterine growth restriction or fetal growth restriction, but at times will use the terms interchangeably.
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Intrauterine growth restriction is defined as the fetal failure of achieving the endorsed growth potential and the diagnosis is made on the basis of ultrasound estimated fetal weight below the 10th centile in the absence of a gold standard for defining this condition. Fetuses with growth restriction are at risk for perinatal morbidity and mortality and for poor long-term health outcomes. In the last 10 years many algorithms have been developed aiming to prevent these consequences. This year new consensus-based definitions for early and late fetal growth restriction, including cut-off values for parameters, have been agreed. An update in diagnosis and management of intrauterine growth restriction, through a review of the latest publications in the field, presents the arguments for decisions necessary to produce national guidelines and recommendations of clinical practice in order to reduce the perinatal morbidity and mortality due to this condition, whose prevalence is estimated at 6-7% of total births in Romania.
Fetal growth
Intrauterine growth restriction
Growth restriction
Perinatal mortality
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Our objective was to determine if sonographic estimate of fetal weight (SEFW) can identify fetal growth restriction (FGR; birthweight < 10% for gestational age [GA]) among patients with preterm (28 to 32 weeks) severe preeclampsia (P SPE). At two centers, all singletons with reliable GA, P SPE, and SEFW within 3 weeks of birth were identified retrospectively. Intrauterine growth restriction was SEFW < or = 10% for GA. Likelihood ratio (LR) and guidelines by an Evidence-Based Medicine Working Group were used. At the two centers, IUGR was suspected in 20% (4 of 20) and 28% (5 of 18) of P SPE, and FGR was noted in 35% and 44%. At one center, suspected intrauterine growth restriction (IUGR) was associated with actual FGR in 50% of the cases and at center II, in 80%. The LR for IUGR to identify FGR was 3.0. We concluded that SEFW is not a useful diagnostic test in identifying FGR among patients with preterm SPE.
Intrauterine growth restriction
Fetal growth
Growth restriction
Fetal weight
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Singleton
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Optimal fetal growth resulting in a 'normally grown' term infant is of paramount importance for assuring a healthy start for postnatal growth and development. Fetal, infant and childhood growth restriction is an important clinical problem for obstetricians, neonatologists, pediatricians and globally, for public health. Worldwide, an estimated 20 million infants are born with low birthweight and a substantial proportion are small for gestational age. Many advances have been made in defining growth restriction by prenatal techniques, thus allowing the recognition of intrauterine growth restriction. Distinguishing infants who are small but have appropriate growth potential from those with growth restriction is important in order to apply obstetric surveillance, anticipate neonatal problems and plan for postneonatal guidance. It is clear that the fetus in growth-restricted pregnancies has limited supply of nutrients and oxygen. The resultant changes, if involving the placenta as well, can lead to circulatory and metabolic changes affecting both short- and long-term survival and development. In this paper, the causes and immediate consequence of being born with low birthweight, intrauterine growth restriction or small for gestational age will be discussed.
Intrauterine growth restriction
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Growth restriction
Placental insufficiency
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