Fetal Growth Restriction

Question 1

Causes of FGR

Answer 1

Maternal medical conditions:
Vascular disease, pregnancy related hypertensive diseases, APS, lupus (NOT hereditary thrombophilias), Substance abuse, maternal malnutrition, pre-gestational diabetes, renal insufficiency, Infectious diseases

FETAL:
Genetic and structural abnormalities (trisomy 13 and 18, confined placental mosaicism, gastroschisis, congenital heart disease), multiple gestation

PLACENTAL:
Abruption, circumvallate, velamentous or marginal cord insertion. Possibly single umbilical artery

Question 2

Neonatal Complications of FGR

Answer 2

Hypoglycemia, hyperbilirubinemia, hypothermia, intraventricular hemorrhage, seizure, sepsis, RDS, NEC, death

Question 3

Timing of delivery

1. EFW 3-10%ile and normal doppers
2. EFW <3%ile or decreased diastolic flow
3. AEDF
4. REDF
5. FGR and oligo

Answer 3

1. 38-36+6
2. 37
3. 33-34
4. 30-32
5. 34-37+6

Question 4

Long-term health consequences for fetus

Answer 4

Increased risk of cognitive and learning disabilities, metabolic syndrome, cardiovascular and endocrine disease

Question 5

What is the recurrence of fetal growth restriction

Answer 5

20%

Question 6

What is the role of umbilical artery Doppler?

Answer 6

Reduces risk of perinatal death by as much as 29% combined with US

Measured in cm/sec

Question 7

Causes of symmetric vs asymmetric

Answer 7

Symmetric- early insult aneuploidy, infection (syphilis, TORCH), malaria

Asymmetric - late. Placental insufficiency