Screening for fetal growth restriction and placental insufficiency

Audette, Melanie C.; Kingdom, John

doi:10.1016/j.siny.2017.11.004

Cited by 162 publications

(127 citation statements)

References 84 publications

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Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5][6] However, given the difficulty in determining the growth potential of the individual fetus, FGR is commonly defined as sonographic estimated fetal weight or abdominal circumference below the 10th percentile for gestational age. 1,8,[10][11][12][13][14][15][16][17][18][19][20] The most common placental findings in pregnancies complicated by FGR are lesions reflective of maternal vascular malperfusion (MVM) pathology, although other pathologies such as fetal vascular malperfusion and chronic villitis have been associated with FGR as well. 1,8,[10][11][12][13][14][15][16][17][18][19][20] The most common placental findings in pregnancies complicated by FGR are lesions reflective of maternal vascular malperfusion (MVM) pathology, although other pathologies such as fetal vascular malperfusion and chronic villitis have been associated with FGR as well.…”

Section: Introductionmentioning

confidence: 99%

“…1,8,[10][11][12][13][14][15][16][17][18][19][20] The most common placental findings in pregnancies complicated by FGR are lesions reflective of maternal vascular malperfusion (MVM) pathology, although other pathologies such as fetal vascular malperfusion and chronic villitis have been associated with FGR as well. 1,23,24 However, the optimal gestational age cut-off that differentiates these two phenotypes of FGR is currently unclear and has been arbitrarily set in previous studies at between 32 and 37 weeks. Early FGR is often associated with preeclampsia, abnormal umbilical artery Doppler findings and poor perinatal outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…10,11,13,15,16,[20][21][22] In recent years, it has been suggested that early and late FGR may represent two distinct entities. 1,2,10,15,18,19,[23][24][25][26][27] More recently, Savchev et al attempted to establish the cut-off using a composite neonatal outcome and a decision tree analysis technique; they identified 32 0/7 weeks at the time of diagnosis as the optimal gestational age cut-off. In contrast, late FGR is associated with a milder degree of placental dysfunction and is less likely to be associated with preeclampsia and changes in umbilical artery Doppler.…”

Section: Introductionmentioning

confidence: 99%

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Defining early vs late fetal growth restriction by placental pathology

Aviram

Sherman

Kingdom

et al. 2018

Acta Obstet Gynecol Scand

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Abbreviations: FGR, fetal growth restriction; MVM, maternal vascular malperfusion; SGA, small-for-gestational age; VUE, villitis of unknown etiology. AbstractIntroduction: Although early and late fetal growth restriction have been suggested to be distinct entities, the optimal gestational age cut-off that differentiates the two conditions is currently unclear and has been arbitrarily set in previous studies between 32 and 37 weeks. We aimed to use placental pathology findings to determine that optimal gestational age cut-off between early and late fetal growth restriction. Material and methods:A retrospective cohort study of all women with singleton gestation who gave birth to a neonate diagnosed as small-for-gestational age (small-for-gestational age, defined as birthweight <10th percentile for gestational age) at a tertiary referral center between January 2001 and December 2015, and for whom placental pathology was available. Placental abnormalities were classified into lesions associated with maternal vascular malperfusion (MVM), fetal vascular malperfusion, placental hemorrhage and chronic villitis. Placental findings were analyzed as a function of gestational age at birth. The analysis was repeated in the subgroups of women without hypertensive complications of pregnancy (to reflect changes associated with isolated small-for-gestational age) and of neonates with severe small-for-gestational age (defined as birthweight <5th percentile), which are more likely to represent true fetal growth restriction.Results: A total of 895 women met the inclusion criteria. The only histological finding that changed with gestational age was MVM pathology, which decreased in frequency with increasing gestational age. We identified a considerable drop in the rate of MVM lesions at 33 weeks of gestation. The rate of MVM pathology in placentas of infants born before 33 0/7 weeks was significantly higher than that observed in placentas of infants born at 33 0/7 weeks or longer: 71.6% vs 27.4%, P < 0.001 for ≥2 MVM lesions, and 35.5% vs 3.5%, P < 0.001 for ≥3 MVM lesions. These findings persisted in the subgroups of women without hypertensive complications of pregnancy (n = 662) and of neonates with severe small-for-gestational age (n = 464).Conclusions: Using placental pathology as a direct measure of the mechanisms underlying fetal growth restriction, the optimal gestational age at birth cut-off which differentiates early from late fetal growth restriction appears to be 33 0/7 weeks. K E Y W O R D Sfetal growth restriction, maternal vascular malperfusion lesions, placental pathology, smallfor-gestational age

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Defining early vs late fetal growth restriction by placental pathology

Aviram

Sherman

Kingdom

et al. 2018

Acta Obstet Gynecol Scand

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“…To date, the definition of IUGR remains elusive and the best way to identify IUGR is yet to be determined . IUGR complicated 3–9% of all pregnancies with 30% of stillborn infants cases . In addition, IUGR is associated with a four‐ to eightfold higher perinatal mortality and a series of neonatal complications (persistent pulmonary hypertension, polycythemia, hypothermia, hypoglycemia, hyperglycemia, pulmonary hemorrhage, premature delivery, asphyxia intrapartum) …”

Section: Introductionmentioning

confidence: 99%

Fetal heart rate monitoring and neonatal outcome in a population of early‐ and late‐onset intrauterine growth restriction

Esposito

Tagliaferri

Giudicepietro

et al. 2019

J of Obstet and Gynaecol

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Aim The early‐onset intrauterine growth restriction (IUGR) is associated with severe placental insufficiency and Doppler abnormalities. The late‐onset IUGR is associated with mild placental insufficiency and normal Doppler velocimetry. The computerized cardiotocographic (cCTG) monitoring is used to evaluate the fetal well‐being in pregnancies complicated by IUGR. Our aim was to investigate the cardiotocographic characteristics of IUGR fetuses and to identify every cCTG difference between Healthy and IUGR fetuses. Methods Four hundred thirty pregnant women were enrolled starting from the 28th week of gestation until the time of delivery: 200 healthy and 230 IUGR fetuses. Fetal heart rate (FHR) baseline (FHR), short‐term variability (STV), long‐term irregularity (LTI), delta, interval index (II), approximate entropy (ApEn), high frequency (HF), low frequency (LF), movement frequency (MF), LF/(HF + MF) ratio (LF/(HF + MF)) and number of decelerations were examined. Newborn baby data were also collected. Results The parameters of short‐ and medium‐term variability discriminate between IUGR and healthy fetuses before 36 weeks including FHR, STV, LTI and delta discriminate between each subgroup of IUGR were compared to each one of the other two (P < 0.05). Conclusion cCTG is a useful tool for the evaluation of chronic hypoxemia, which causes a delay in the maturation of all components of the autonomic and central nervous system. However, cCTG requires integration with fetal ultrasound and Doppler vessels evaluation to improve the ability to predict the neonatal outcome.

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Preeclampsia, Fetal Growth Restriction, and 24-Month Neurodevelopment in Very Preterm Infants

Check,

Shuster,

Hofheimer

et al. 2024

JAMA Netw Open

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ImportancePreeclampsia has direct influences on a developing fetus and may impact postnatal health, and fetal growth restriction (FGR) is often seen co-occurring with preeclampsia. The development of children born very preterm after preeclampsia diagnosis with and without FGR is not well characterized.ObjectiveTo examine the associations of preeclampsia and FGR with developmental and/or behavioral outcomes in a cohort of very preterm infants.Design, Setting, and ParticipantsIn this cohort study, infants in the prospective Neonatal Neurobehavior and Outcomes in Very Preterm Infants study were enrolled between April 2014 and June 2016 from 9 US university-affiliated neonatal intensive care units (NICUs). Eligible infants were born before 30 weeks’ gestation. Infants were excluded for any major congenital anomalies and for maternal age younger than 18 years or cognitive impairment impacting the ability to provide informed consent. Data analysis was performed from November 2023 to January 2024.ExposureMaternal preeclampsia and FGR in very preterm infants.Main Outcomes and MeasuresThe Bayley-III cognition, motor, and language scores less than 85 (−1 SD) indicated developmental delay. Child Behavior Checklist/Preschool 1.5-5 T-scores greater than or equal to 64 for internalizing, externalizing, or total problems indicated clinical importance.ResultsOf 704 infants enrolled, 529 (mean [SD] gestational age, 27.0 [1.9] weeks; 287 male [54.3%]) were studied at 24-month follow-up. A total of 94 infants’ mothers had preeclampsia (23.2%), and 46 infants (8.7%) had FGR. In adjusted models, preeclampsia was not associated with Bayley-III (cognitive, B = 3.43 [95% CI, −0.19 to 6.66]; language, B = 3.92 [95% CI, 0.44 to 7.39]; motor, B = 1.86 [95% CI, −1.74 to 5.47]) or Child Behavior Checklist/Preschool 1.5-5 (internalizing, B = −0.08 [95% CI, −2.58 to 2.73]; externalizing, B = 0.69 [95% CI, −1.76 to 3.15]; total, B = 0.21 [95% CI, −2.48 to 2.91]) outcomes. FGR was associated with significantly lower Bayley-III scores (cognitive, B = −8.61 [95% CI, −13.33 to −3.89]; language, B = −8.29 [95% CI, −12.95 to −3.63]; motor, B = −7.60 [95% CI, −12.40 to −2.66]), regardless of preeclampsia status.Conclusions and RelevanceIn this cohort study of preterm infants, preeclampsia was not associated with developmental and/or behavioral outcomes, but infants with FGR may be prone to developmental delays. These findings suggest future areas of research for understanding the roles of preeclampsia and FGR separately and together in early child development for preterm infants.

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Screening for fetal growth restriction and placental insufficiency

Cited by 162 publications

References 84 publications

Defining early vs late fetal growth restriction by placental pathology

Defining early vs late fetal growth restriction by placental pathology

Fetal heart rate monitoring and neonatal outcome in a population of early‐ and late‐onset intrauterine growth restriction

Preeclampsia, Fetal Growth Restriction, and 24-Month Neurodevelopment in Very Preterm Infants

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