The first group includes structural and chromosomal/genetic anomalies (trisomies 13 and 18 genetic conditions such as Russel Silver Syndrome), congenital infections (rubella, cytomegalovirus, toxoplasmosis) and inborn errors of metabolism.
Small fetuses can be divided into two groups: non-placenta mediated growth restriction and placenta mediated. The causes of FGR are heterogeneous and can be classified as fetal, maternal, environmental, and placental. Correct surveillance, antenatal management and timing of delivery can improve fetal and neonatal outcomes. Prenatal recognition of FGR remains the main challenge in daily obstetric practice. Fetal growth restriction is probably among the obstetric entities where there is the greatest variation in clinical practice, in terms of monitoring and recommended gestational age at delivery. Īt present there is no effective treatment to reverse the course of FGR except delivery. It has been postulated that cardiovascular remodelling is due to hemodynamic redistribution and adaptation to hypoxia and insufficient nutrition. These observations were first made in 1989 by Barker and colleagues and confirmed in the last few decades.
FGR is also associated with poor postnatal growth and numerous studies in both humans and animals have shown an association between low birth weight and development of cardiovascular disease including increased risk of hypertension, diabetes, dyslipidemia and coagulation in children and adults. įGR is a complex and multifactorial disorder affecting the fetal development that often results in multiple perinatal complications and currently represents a major risk factors for long term poor neurological outcome. A recent study has shown how the incidence of perinatal death is highest in those with a birth weight below the 2.3 rd centile, falling gradually with an increasing birth weight up to the 80 th and 90 th centiles, at which the lowest death rates occur. The perinatal outcome of FGR is dependent on the severity of growth restriction an estimated fetal weight below the 3 rd centile and/or abnormal umbilical artery Doppler are strongly associated with adverse perinatal outcome. Early FGR by definition is diagnosed at or below 32 weeks and differs from late onset FGR also in terms of its clinical manifestations, association with hypertension, patterns of deterioration and severity of placental dysfunction. Fetal growth restriction (FGR) is both a common obstetric condition and a major cause of perinatal morbidity and mortality.
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