Screening for fetal growth restriction and placental insufficiency |
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Affiliation: | 1. Lunenfeld–Tanenbaum Research Institute, Toronto, Canada;2. Faculty of Medicine, University of Toronto, Toronto, Canada;3. Maternal–Fetal Medicine Division, Department of Obstetrics and Gynaecology, Sinai Health System, Toronto, Canada;1. Intermountain Healthcare, University of Utah Health Sciences, Intermountain Medical Center, Maternal Fetal Medicine, Salt Lake City, UT, USA;2. Mayo Clinic, Rochester, MN, USA;1. Department of Obstetrics and Gynaecology, Women''s and Children''s Hospital, Adelaide, Australia;2. Maternal Fetal Medicine, Sunshine Hospital, Western Health, Saint Albans, VIC, Australia;3. Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC, Australia;4. Robinson Research Institute, Adelaide Medical School, North Adelaide, SA, Australia;5. Department of Obstetrics and Gynaecology, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia |
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Abstract: | Fetal growth restriction (FGR) continues to be a leading cause of preventable stillbirth and poor neurodevelopmental outcomes in offspring, and furthermore is strongly associated with the obstetrical complications of iatrogenic preterm birth and pre-eclampsia. The terms small for gestational age (SGA) and FGR have, for too long, been considered equivalent and therefore used interchangeably. However, the delivery of improved clinical outcomes requires that clinicians effectively distinguish fetuses that are pathologically growth-restricted from those that are constitutively small. A greater understanding of the multifactorial pathogenesis of both early- and late-onset FGR, especially the role of underlying placental pathologies, may offer insight into targeted treatment strategies that preserve placental function. The new maternal blood biomarker placenta growth factor offers much potential in this context. This review highlights new approaches to effective screening for FGR based on a comprehensive review of: etiology, diagnosis, antenatal surveillance and management. Recent advances in novel imaging methods provide the basis for stepwise multi-parametric testing that may deliver cost-effective screening within existing antenatal care systems. |
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Keywords: | Fetal growth restriction Small for gestational age Placental insufficiency Doppler ultrasound Biomarkers |
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