fetal growth restriction

  • related: OBGYN

  • pt: ultrasound-estimated fetal weight <10th percentile for gestational age

  • cause: increased umbilical artery resistance

    • symmetric:
      • entire fetus affected
      • first trimester
      • Chromosomal abnormalities, infection (eg, cytomegalovirus, toxoplasmosis)
    • asymmetric:
      • head sparing (blood redistribute to brain and away from abd)
      • 2nd/3rd trimester
      • maternal comorbidities (eg, renal disease, hypertension, diabetes mellitus), and multiple gestation

  • sx:

    • placental insufficiency that impedes normal fetal growth.
    • fetal hypoxia
    • preterm delivery

  • management:

    • Screening serial umbilical artery Doppler sonography and biophysical profiles to evaluate for worsening placental insufficiency and the development of fetal hypoxia
    • Growth measurements are performed every 3-4 weeks.
    • Absent or reversed umbilical artery end-diastolic flow suggests placental insufficiency and impending fetal hypoxia, particularly with concomitant oligohydramnios, and is an indication for delivery.