Fetal Growth Restriction at the Limits of Viability

Abstract

The outcome of early small-for-gestational age and/or intrauterine growth-restricted fetuses is reviewed. In these fetuses the outcome appears to be considerably poorer than that of appropriately grown fetuses and this seems mainly to be caused by intrauterine malnutrition rather than by hypoxemia. Active management of intrauterine growth restriction at the limits of viability may not be commenced before 26 weeks of gestation.

Early onset fetal growth restriction

“…Few data exist regarding periviable growth restricted babies, a category which is commonly associated with poor outcome [92]. In 2014 Story et al [102] reviewed the outcomes of 20 FGR fetuses diagnosed <24 weeks and EFW <3 rd centile reporting a 67% preterm delivery rate and a better than expected survival to neonatal discharge rate of 60%.…”

“…A remarkable reduction in the gestational age cut off for neonatal survival has been achieved, and current neonatal practice has lead to the survival of fetuses born from 22 weeks onwards [90]. Recently published data report a better than expected prognosis for periviable small fetuses [91], however according to Visser et al [92] active intervention by delivery of early FGR fetuses should not be recommended before 26 weeks as their outcome is comparable to that of AGA infants born at a 2-weeks earlier gestational age. Counseling plays a crucial role, however in a scenario of lacking evidence it is usually individualized on the basis of the clinical features and the option of pregnancy termination may be discussed when legally available.…”

A Uniform Management Approach to Optimize Outcome in Fetal Growth Restriction

“…3, Table 2), and the outcome is comparable to that of appropriate for gestational age infants born at a 2-week shorter gestational age. 57 Accordingly, the threshold for delivery needs to be higher at earlier gestational age. The neurodevelopmental outcome of growth-restricted babies has received growing attention in recent years, given the impact on quality of life.…”

Retinoic acid signaling reduction recapitulates the effects of alcohol on embryo size

“…Fetal, developmental, or intrauterine growth restriction (FGR, DGR, or IUGR), also sometimes known as small for gestational age (SGA), is commonly defined as “a fetus that fails to reach its potential growth” during embryogenesis (Mandruzzato et al, ; Visser, Bilardo, & Lees, ). Close to 8% of human pregnancies develop FGR, making it a major clinical problem affecting the lives of numerous babies worldwide.…”