Screening for fetal growth restriction and placental insufficiency

• Published in: Seminars in fetal & neonatal medicine 2018-04, Vol.23 (2), p.119-125
• Main Authors: Audette, Melanie C., Kingdom, John C.
• Format: Article
• Language: English
• Subjects: Biomarkers; Biomarkers - blood; Doppler ultrasound; Female; Fetal growth restriction; Fetal Growth Retardation - diagnostic imaging; Fetal Growth Retardation - etiology; Fetal Growth Retardation - mortality; Fetal Growth Retardation - physiopathology; Humans; Infant, Newborn; Male; Perinatal Mortality; Placental insufficiency; Placental Insufficiency - blood; Placental Insufficiency - diagnostic imaging; Placental Insufficiency - physiopathology; Placental Insufficiency - therapy; Pregnancy; Severity of Illness Index; Small for gestational age; Terminology as Topic; Ultrasonography, Doppler - trends; Ultrasonography, Prenatal - methods; Ultrasonography, Prenatal - trends; Umbilical Arteries - diagnostic imaging; Umbilical Arteries - physiopathology; Uterine Artery - diagnostic imaging; Uterine Artery - physiopathology
• ISSN: 1744-165X; 1878-0946
• DOI: 10.1016/j.siny.2017.11.004

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.