: This article reviews the literature about the diagnosis, antepartum surveillance, and timing of delivery of fetuses suspected to be small for gestational age/growth restricted. Several guidelines have been issued by major professional organizations, including ISUOG and SMFM. The differences in recommendations, in particular about the use of Doppler velocimetry of the ductus venosus and middle cerebral artery have created confusion among clinicians and this review intends to clarify and highlight the available evidence which is pertinent to clinical management. A fetus who is small for gestational age is frequently defined as one with an estimated fetal weight below the tenth percentile. This condition is syndromic in nature, and has been frequently attributed to fetal growth restriction, a constitutionally small fetus, congenital infections, chromosomal abnormalities, or genetic conditions. Small for gestational age is not synonymous with fetal growth restriction, which is defined by deceleration of fetal growth determined by a change in fetal growth velocity. An abnormal umbilical artery Doppler pulsatility index reflects increased impedance to flow in the umbilical circulation, and is considered to be an indicator of placental disease. The combined finding of an EFW below the 10th percentile and abnormal umbilical artery Doppler velocimetry has been widely accepted as indicative of fetal growth restriction. Clinical studies have shown that the gestational age at diagnosis can be used to subclassify suspected fetal growth restriction into early and late, depending upon whether the condition is diagnosed before or after 32 weeks. The early type is associated with umbilical artery Doppler abnormalities, while the late form often has a low pulsatility index in the middle cerebral artery. A large randomized clinical trial indicates that in the context of early suspected fetal growth restriction, the combination of computerized cardiotocography and fetal ductus venosus Doppler improves outcomes, such that 95% of surviving infants have normal neurodevelopmental outcome at 2 years of age. A low middle cerebral artery pulsatility index is associated with adverse perinatal outcome in late fetal growth restriction however there is no evidence supporting its use to determine delivery timing. Nonetheless, an abnormality in middle cerebral artery Doppler could be valuable to increase the surveillance of the fetus at risk. We propose that assessment of fetal size, growth rate, uteroplacental Doppler indices, cardiotocography, and maternal conditions (i.e. hypertension) in the context of gestational age are important factors in optimizing the outcome of suspected fetal growth restriction.

Clinical Opinion: The diagnosis and management of suspected fetal growth restriction: an evidence-based approach / Lees, C; Romero, R; Stampalija, T; Dall'Asta, A; Devore, G; Prefumo, F; Frusca, T; Visser, G H A; Hobbins, J; Baschat, A; Bilardo, C M; Galan, H; Campbell, S; Maulik, D; Figueras, F; Lee, W; Unterscheider, J; Valensise, H; Da Silva Costa, F; Salomon, L; Poon, L; Ferrazzi, E; Mari, G C; Rizzo, G; Kingdom, J; Kiserud, T; Hecher, K. - In: AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY. - ISSN 0002-9378. - (2021). [10.1016/j.ajog.2021.11.1357]

Clinical Opinion: The diagnosis and management of suspected fetal growth restriction: an evidence-based approach

Dall'asta, A
Membro del Collaboration Group
;
Frusca, T
Membro del Collaboration Group
;
2021

Abstract

: This article reviews the literature about the diagnosis, antepartum surveillance, and timing of delivery of fetuses suspected to be small for gestational age/growth restricted. Several guidelines have been issued by major professional organizations, including ISUOG and SMFM. The differences in recommendations, in particular about the use of Doppler velocimetry of the ductus venosus and middle cerebral artery have created confusion among clinicians and this review intends to clarify and highlight the available evidence which is pertinent to clinical management. A fetus who is small for gestational age is frequently defined as one with an estimated fetal weight below the tenth percentile. This condition is syndromic in nature, and has been frequently attributed to fetal growth restriction, a constitutionally small fetus, congenital infections, chromosomal abnormalities, or genetic conditions. Small for gestational age is not synonymous with fetal growth restriction, which is defined by deceleration of fetal growth determined by a change in fetal growth velocity. An abnormal umbilical artery Doppler pulsatility index reflects increased impedance to flow in the umbilical circulation, and is considered to be an indicator of placental disease. The combined finding of an EFW below the 10th percentile and abnormal umbilical artery Doppler velocimetry has been widely accepted as indicative of fetal growth restriction. Clinical studies have shown that the gestational age at diagnosis can be used to subclassify suspected fetal growth restriction into early and late, depending upon whether the condition is diagnosed before or after 32 weeks. The early type is associated with umbilical artery Doppler abnormalities, while the late form often has a low pulsatility index in the middle cerebral artery. A large randomized clinical trial indicates that in the context of early suspected fetal growth restriction, the combination of computerized cardiotocography and fetal ductus venosus Doppler improves outcomes, such that 95% of surviving infants have normal neurodevelopmental outcome at 2 years of age. A low middle cerebral artery pulsatility index is associated with adverse perinatal outcome in late fetal growth restriction however there is no evidence supporting its use to determine delivery timing. Nonetheless, an abnormality in middle cerebral artery Doppler could be valuable to increase the surveillance of the fetus at risk. We propose that assessment of fetal size, growth rate, uteroplacental Doppler indices, cardiotocography, and maternal conditions (i.e. hypertension) in the context of gestational age are important factors in optimizing the outcome of suspected fetal growth restriction.
Clinical Opinion: The diagnosis and management of suspected fetal growth restriction: an evidence-based approach / Lees, C; Romero, R; Stampalija, T; Dall'Asta, A; Devore, G; Prefumo, F; Frusca, T; Visser, G H A; Hobbins, J; Baschat, A; Bilardo, C M; Galan, H; Campbell, S; Maulik, D; Figueras, F; Lee, W; Unterscheider, J; Valensise, H; Da Silva Costa, F; Salomon, L; Poon, L; Ferrazzi, E; Mari, G C; Rizzo, G; Kingdom, J; Kiserud, T; Hecher, K. - In: AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY. - ISSN 0002-9378. - (2021). [10.1016/j.ajog.2021.11.1357]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11381/2912753
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