Fetal growth restriction: unresolved issues of risk stratification, early diagnosis, and obstetric management

Abstract

Fetal growth restriction (FGR) refers to pregnancy complications associated with an increased risk of perinatal morbidity and mortality and is defined in the Russian-language literature as the fetal size and weight retardation in relation to the norm for a given gestational age, and in the English-language literature – as the inability of the fetus to realize its genetically determined growth potential. FGR is the cause of 43% of stillbirths of unspecified etiology, and some cases remain undiagnosed even in high-risk populations due to the lack of universal diagnostic standards for this pathology. The review presents a critical analysis of the existing definitions of FGR, the latest data on risk factors, an assessment of diagnostic methods for its early and late forms, the prospects of using biomarkers and instrumental methods of examination in predicting adverse perinatal outcomes, and an algorithm for the management of pregnancy complicated by FGR. For a more complete coverage of the literature and deeper understanding of the nosology, attention is focused on FGR that is not accompanied by preeclampsia and other hypertensive disorders, which occur in about 30% of cases. Key words: placental insufficiency, fetometry, percentile, pulsatility index, fetal growth restriction For citation: Podzolkova N.M., Denisova Yu.V., Skvortsova M.Yu., Denisova T.V., Shovgenova D.S. Fetal growth restriction: unresolved issues of risk stratification, early diagnosis, and obstetric management. Vopr. ginekol. akus. perinatol. (Gynecology, Obstetrics and Perinatology). 2021; 20(5): 76–86. (In Russian). DOI: 10.20953/1726-1678-2021-5-76-86

Current views on the diagnosis and prognosis of fetal growth restriction (A literature review)

“…В отечественной практике долгие годы диагноз «задержка роста плода» ставили на основании трех форм отставания предполагаемой массы тела от нормальной массы для срока гестации: симметричной, асимметричной и смешанной [11]. По данным исследования М.А.…”

“…Ранняя ЗРП преобладает в 0,5-1 % случаев, более тяжелая чаще ассоциируется с нарушениями кровотока в системе мать -плацента -плод. Патология плаценты, лежащая в основе раннего ЗРП, идентична таковой при ранней преэклампсии (нарушении перфузии маточных артерий), что объясняет взаимосвязь ранней преэклампсии и ЗРП [11][12][13]. Выраженную ЗРП наблюдают чаще при раннем фенотипе.…”