ACOG Practice Bulletin: Fetal Growth Restriction, May 2013

Question 0

Etiologies of growth restriction

1. Maternal:
2. Substance abuse
3. Multiple gestation
4. Teratogens:
5. Infection:
6. Genetic or structural disorders
7. Placental disorders and umbilical cord abnormalities:

Answer 0

1. pregestational DM, renal insufficiency, autoimmune disease, cyanotic cardiac disease, hypertension, antiphospholipid antibody syndrome
2. cyclophosphamide, valproic acid, warfarin
3. malaria, CMV, rubella, toxoplasmosis, syphilis
4. trisomy 13 and 18, congenital heart disease, gastroschisis
5. abruption, infarction, circumvallate shape, hemangioma, chorioangioma, velamentous or marginal cord insertion

Question 1

Definitions

1. Fetal growth restriction:
2. SGA:

Answer 1

1: EFW <10th % for GA
2: birth weight <10th % for GA

Question 2

Number of Alcoholic drinks needed to increase SGA risk:

Answer 2

1-2

Question 3

Tobacco increases the risk of SGA by what amount?

Answer 3

Increased 3.5 fold

Question 4

SGA risk for twins:

For triplets:

Answer 4

25%

60%

Question 5

Infection accounts for what percent of fetal growth restriction?

What is the leading worldwide infectious cause?

Answer 5

5 to 10%

Malaria

Question 6

What percentage of fetuses with trisomy 13 or 18 will be growth restricted?

What percent with gastroschisis?

Answer 6

Up to 50%

25%

Question 7

What neonatal risks are associated with SGA?

Answer 7

Hypoglycemia, hyperbilirubinemia, hypothermia, IVH, NEC, seizures, sepsis, RDS, and neonatal death

Question 8

What is the risk of fetal death for EFW less than 10%?
Less than 5%?
What ultrasound findings further increases the risk of death?

Answer 8

1.5%
2.5%
Absent or reversed end-diastolic flow of the umbilical artery

Question 9

What childhood or adult conditions are associated with fetal growth restriction?

Answer 9

Cognitive delay, obesity, type II diabetes mellitus, CAD and stroke

Question 10

How do we screen for fetal growth restriction?

What conditions can compromise screening?

Answer 10

Fundal height measurements.
Greater than 3 cm is abnormal

Obesity and leiomyomas

Question 11

What are the four components of biometry?

What additional studies should be added if growth restriction is determined?

Answer 11

Biparietal diameter, head circumference, abdominal circumference, femur length

AFI and umbilical artery Dopplers

Question 12

What follow-up is recommended for fetal growth restriction?

Answer 12

Growth ultrasounds every 3 to 4 weeks and antenatal testing and Dopplers after 24 weeks

Question 13

When do SMFM and ACOG recommend delivery for isolated growth restriction?

And with additional risk factors such as oligo, abnormal Dopplers, maternal risk factors?

Answer 13

38 to 39w6d

34 to 37w6d

Question 14

What factors should be considered if delivering a severely premature infant?

Answer 14

If less than 32 weeks, give magnesium sulfate for neuro protection; if less than 34 weeks give antenatal steroids

Question 15

What is the recurrence risk for SGA?

Should antenatal testing be recommended for a history of SGA?

What prevention methods are recommended?

Answer 15

20%

No

There are no validated prevention methods