Prenatal diagnosis of fetal growth restriction with polyhydramnios, etiology and impact on postnatal outcome

Abstract

To assess the spectrum of different etiologies, the intrauterine course, outcome and possible prognostic markers in prenatally detected fetal growth restriction (FGR) combined with polyhydramnios. Retrospective study of 153 cases with FGR combined with Polyhydramnios diagnosed by prenatal ultrasound over a period of 17 years. Charts were reviewed for ultrasound findings, prenatal and postnatal outcome. All cases were categorized into etiological groups and examined for differences. Five etiological groups were identified: chromosomal anomalies (n = 64, 41.8%), complex malformation syndromes (n = 37, 24.1%), isolated malformations (n = 24, 15.7%), musculoskeletal disorders (n = 14, 9.2%) and prenatal non-anomalous fetuses (n = 14, 9.2%). Subgroups showed significant disparities in initial diagnosis of combination of both pathologies, Ratio AFI/ gestational weeks and Doppler ultrasound examinations. Overall mortality rate was 64.7%. Fetuses prenatally assigned to be non-anomalous, showed further complications in 42.9% (n = 6). Fetuses prenatally diagnosed with FGR combined with polyhydramnios are affected by a high morbidity and mortality. Five etiologic groups can be differentiated, showing significant disparities in prenatal and postnatal outcome. Even without recognizable patterns prenatally, long-term-follow up is necessary, as neurodevelopmental or growth delay may occur.

Accuracy of Polyhydramnios for Detection of Fetal Anomalies on Ultrasound

“…Different to our study, Walter et al reported congenital diaphragmatic the single most common isolated anomaly in 41.7% of cases, while cardiac malformations were noted in 29.2% of cases. 16 Overall, diagnostic accuracy in our study was 92.41%, with sensitivity, specificity, positive predictive value and negative predictive value of polyhydramnios for detecting fetal anomalies of 83.3%, 91.41%, 29.4% and 99.2%, respectively. Eshiba et al have reported the overall diagnostic accuracy using sonographic methods to be 76%, with diagnostic accuracy reaching up to 100% when combined with MRI.…”

Epidemiology of Adverse Outcomes in Teenage Pregnancy—A Northeastern Romanian Tertiary Referral Center

“…-Maternal anemia-a maternal hemoglobin concentration less than 11 mg/dL [16]; -Fetal growth restriction (FGR)-an estimated fetal weight at or below the 3rd percentile compared to normal fetal weight for gestational age associated with abnormal Doppler [17]; -Fetuses small for gestational age (SGA)-fetuses with birthweight less than the 10th percentile for the gestational age [18]; -Fetuses large for gestational age-birthweight >90th percentile for gestational age [19]; -Premature birth-any birth before 37 weeks of gestation [20]; -PROM (prelabor rupture of membranes)-the rupture of membranes prior to the onset of labor [21]; -Chorioamnionitis-infection of the amniotic sac and membranes [22]; -Gestational hypertension-blood pressure above 140/90 mmHg after 20 weeks in previously normotensive women without proteinuria or other signs/symptoms of preeclampsia-related organ dysfunction [15]; -Preeclampsia was defined as the new onset of hypertension and proteinuria or hypertension and significant end-organ dysfunction with/without proteinuria after 20 weeks of gestation in a previously normotensive woman/new onset of proteinuria, significant end-organ dysfunction or both after 20 weeks of gestation in a woman with chronic/pre-existing hypertension (it may also develop postpartum) [15]. -HELLP syndrome was defined as the presence of hemolysis, elevated liver enzymes and low platelets [15]; -Cholestasis of pregnancy-a liver disorder in the late second and early third trimester of pregnancy characterized by pruritus with increased serum bile acids and other liver function tests [23].…”

“…Resulting from an association of multiple factors such as infections, nutrition deficiency and a lack of correct supplementation, anemia determines premature birth, low birth weight (FGR or SGA) and even low Apgar scores. Many studies underlined the correlation between maternal anemia and premature birth [15][16][17][18], and the correlation is a major source of increased neonatal morbidity and mortality. Moreover, anemia leading to FGR and SGA birth is involved in unfavorable fetal outcomes with high morbidity and mortality [17,18,36,38,39].…”

“…Many studies underlined the correlation between maternal anemia and premature birth [15][16][17][18], and the correlation is a major source of increased neonatal morbidity and mortality. Moreover, anemia leading to FGR and SGA birth is involved in unfavorable fetal outcomes with high morbidity and mortality [17,18,36,38,39].…”

“…Moreover, anemia might have a negative impact on fetal growth, causing both FGR or SGA birth, as stated before. A proper prenatal care with correct management and the mending of teenage mother's anemia might reduce the number of preterm deliveries and FGR or SGA [17,36,37].…”