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Fetal Growth Restriction
14
DELIVERY
If < 32 weeks: MgSO4 4g IVI
If < 34 weeks: Corticosteroids
FGR alone is NOT an indication for C/S
38 weeks
37 - 38 weeks
REDF
AEDF
UA PI > 95th centile
EFW < 3rd, IUGR with Oligo
IUGR only
TIMING OF
DELIVERY
40 weeks
32 weeks
34 weeks
Aetiology ?
Timing
of
Delivery
Pregnancy Duration 26 - 32 Weeks
FGR with AC < 10th percentile and
Umbilical Artery PI > 95th percentile.
RCT: 3 groups
- Early changes in DV waveform: DV-PI > p95th
- Late changes in DV waveform: Absent / Reversed A-wave
- Change in Short Term Variation (STV) on CTG
The Trial of Randomized Umbilical and Fetal Flow in Europe
TRUFFLE STUDY
ASSESSMENT
UxA / UA / MCA / DV
q 2 weekly
CMV / Syphilis / Malaria
- Ultrasound Biometry
- Doppler Studies
- Infection
- Anatomy
- Chromosome Studies
Prevention
Asprin
ASPRE TRIAL 150mg Nocte
? Sildenafil
Success in Animal Studies
Under Investigation
Hx / SF
Diagnosis
Ultrasound
- Biometry
- AFI
- Doppler Flow
- Fetal Anatomy
Fetal
Growth
Restriction
Fetal
Growth
Restriction
Symmetric
FGR
- 20-30%
- All organs proportionally
small
- Global impairment
Assymmetric
Aetiology
- 70-80%
- AC < HC
- Fetus adapts to hostile
environment
Not Fulfilling Growth Potential
Maternal
Fetal
Placental
- Less than p10
- Crossing centiles
- What about the constitutionally small fetus?
- Chronic Vascular Disease
- PET / DM / Renal Disease
- Teratogens: Smoking / Alcohol
- Assisted Reproductive Techniques
- Poor Maternal Nutrition
- Short Pregnancy Interval
- Extremes of Age
- Fetal Genetic Abnormalities (5-20%)
- Fetal Infection (5-10%)
- Fetal Structural Anomaly
- Multiple Gestation
- Placental Mosaicism
- Ischaemia Placental Disease
- Cord Abnormalities
- Placental Anomalies
FGR
= Adverse Outcomes
(2x if < p10)
Hypoglycaemia
Hyperbilirubinaemia
Hypothermia
IVH
NEC
RDS
Seizures
Sepsis
- Intrauterine / Neonatal Death
- Complications of Prematurity
- Cognitive Delay
- Diseases in Adulthood
(Barkers Hypothesis)