Prenatal Diagnosis of Fetal Growth Restriction With Polyhydramnios: Etiology and Impact on Postnatal Outcome

Abstract

Purpose: 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. Methods: 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.Results: 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). Conclusion: 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.

Os fatores determinantes e as complicações oriundas do crescimento fetal restrito

“…e o feto é simetricamente pequeno. Após decorrido o insulto agudo, o feto cresce normalmente, pois o desenvolvimento celular presente é normal, mas se conserva pequeno por toda a vida, em razão de não alcançar o número de células adequado(WALTER, 2022) Brazilian Journal of Development,Curitiba, v.8, n.11, p. 73283-73298, nov., 2022 Os principais determinantes desse insulto agudo no início da gestação são a exposição a elementos químicos, infecções congênitas, principalmente por citomegalovírus, parvovirus e rubéola, anomalias congênitas, drogas, radiações ionizantes e as aneuploidias (CARVALHO, 2022).9.2 ASSIMÉTRICO TIPO 2Corresponde a 70 a 80% das ocorrências. Assim, o feto se exibe alongado e emagrecido, com a cabeça relativamente grande em comparação ao abdome, remetendo a assimetria.…”