Women's Health Matters: Fetal Growth Restriction-Handouts

Handouts - Fetal Growth Restriction

Pdf Summary

Fetal Growth Restriction (FGR) affects about 10% of pregnancies and is a leading cause of infant morbidity and mortality with long-term risks including metabolic syndromes, cardiovascular and endocrine diseases, and neurologic impairments. FGR refers to fetuses with estimated fetal weight (EFW) or abdominal circumference (AC) below the 10th percentile; not all such fetuses are small for gestational age (SGA) at birth due to constitutional size differences.<br /><br />Diagnosis relies on ultrasound measurements (BPD, HC, AC, femur length) with the Hadlock and Williams growth charts commonly used. Differentiating pathologic FGR from constitutionally small fetuses remains a challenge. FGR is classified by timing (early before 32 weeks, more severe; late after 32 weeks, milder) and severity (EFW below 3rd percentile indicating higher risk).<br /><br />Etiologies include maternal diseases (hypertension, diabetes, autoimmune), placental dysfunction, and fetal anomalies or chromosomal issues. There is no proven prevention; nutritional supplements, aspirin, low molecular weight heparin, and sildenafil lack consistent evidence.<br /><br />Management involves careful monitoring primarily with umbilical artery Doppler studies. Abnormal Doppler indicating increased placental resistance helps identify pathological FGR and reduce perinatal death risk. Ductus venosus and middle cerebral artery Dopplers and uterine artery Doppler do not have routine clinical utility for delivery timing.<br /><br />Key studies like the GRIT and TRUFFLE trials guide delivery timing: delivery is recommended at 37 weeks for decreased diastolic flow or severe FGR, at 33-34 weeks for absent end-diastolic flow, and at 30-32 weeks if reverse end-diastolic flow is present. Antenatal corticosteroids and magnesium sulfate are recommended before preterm delivery for fetal protection. Cesarean delivery is often considered in severe cases due to increased intrapartum risks.<br /><br />Fetal surveillance includes weekly NSTs and biophysical profiles, with increased frequency if Doppler abnormalities occur. Delivery timing balances risks of prematurity against intrauterine compromise, influenced by fetal weight, gestational age, Doppler findings, and maternal health.<br /><br />Overall, FGR remains a complex condition requiring individualized assessment and multidisciplinary management to optimize perinatal outcomes.

Keywords

Fetal Growth Restriction

FGR

Small for Gestational Age

Ultrasound Measurements

Hadlock Growth Chart

Placental Dysfunction

Umbilical Artery Doppler

GRIT Trial

TRUFFLE Trial

Preterm Delivery