Fetal Growth Restriction – Diagnostic Work-up, Management and Delivery

Abstract

Fetal or intrauterine growth restriction (FGR/IUGR) affects approximately 5 – 8% of all pregnancies and refers to a fetus not exploiting its genetically determined growth potential. Not only a major cause of perinatal morbidity and mortality, it also predisposes these fetuses to the development of chronic disorders in later life. Apart from the timely diagnosis and identification of the causes of FGR, the obstetric challenge primarily entails continued antenatal management with optimum timing of delivery. In order to minimise premature birth morbidity, intensive fetal monitoring aims to prolong the pregnancy and at the same time intervene, i.e. deliver, before the fetus is threatened or harmed. It is important to note that early-onset FGR (< 32 + 0 weeks of gestation [wks]) should be assessed differently than late-onset FGR (≥ 32 + 0 wks). In early-onset FGR progressive deterioration is reflected in abnormal venous Doppler parameters, while in late-onset FGR this manifests primarily in abnormal cerebral Doppler ultrasound. According to our current understanding, the “optimum” approach for monitoring and timing of delivery in early-onset FGR combines computerized CTG with the ductus venosus Doppler, while in late-onset FGR assessment of the cerebral Doppler parameters becomes more important.

Curcumin: Could This Compound Be Useful in Pregnancy and Pregnancy-Related Complications?

“…The placenta has the fundamental role of transferring nutrients to the fetus, and alterations in placental function have severe effects on fetal growth. Placental insufficiency is the most common cause of fetal growth restriction (FGR), a serious condition that affects 3-7% of all newborns [95]. Although the pathophysiology of FGR is not completely known, excessive oxidative stress and inflammation, as well as the activation of a complex network of several signaling pathways, appear to be involved [95,96].…”

“…Placental insufficiency is the most common cause of fetal growth restriction (FGR), a serious condition that affects 3-7% of all newborns [95]. Although the pathophysiology of FGR is not completely known, excessive oxidative stress and inflammation, as well as the activation of a complex network of several signaling pathways, appear to be involved [95,96]. The antioxidant and anti-inflammatory effects exerted by curcumin on the placenta [53] were confirmed in a mouse model of FGR fed with a low-protein (LP) diet [16].…”

Pr-AKI: Acute Kidney Injury in Pregnancy – Etiology, Diagnostic Workup, Management

“…In addition to the above-listed symptoms, a first flare-up of SLE during pregnancy significantly increases the risk of pregnancy-associated complications. In addition to the potential consequences for the mother such as AKI, aggravation of lupus with multiorgan involvement, thromboembolic events (TVT, LAE) or the development of preeclampsia or HELLP syndrome, complications may also include fetal complications such as preterm birth or miscarriage, fetal growth restriction or the development of neonatal lupus 57 , 58 , 59 , 60 .…”

miRNAs and Their Gene Targets—A Clue to Differentiate Pregnancies with Small for Gestational Age Newborns, Intrauterine Growth Restriction, and Preeclampsia

“…IUGR is a condition that affects 5–10% of pregnancies, characterized by slow intrauterine growth of the fetus with an expected fetal weight below the 10th percentile, assessed for gestational age and gender, associated with abnormal Doppler ultrasound findings in the vessels of fetus and umbilical cord [ 7 , 8 ]. Early IUGR (diagnosed at or below 32 GW) differs from late-onset IUGR (diagnosed after 32 GW) in terms of its clinical manifestations, association with hypertension, patterns of deterioration, and severity of placental dysfunction [ 9 ].…”