What are the novel findings of this work?This research adds to the knowledge of the incidence, clinical features and perinatal outcome of fetuses with anomalous late-onset fetal growth restriction (FGR). The majority of cases with anomalous late-onset FGR are associated with isolated structural malformations. Anomalous late-onset FGR is associated with a higher incidence of respiratory complications at birth and admission to the neonatal intensive care unit (NICU) and with a longer stay in the NICU compared with non-anomalous late-onset FGR.
What are the clinical implications of this work?The identification of anomalies in the context of late-onset FGR is associated with an increased incidence of composite adverse perinatal outcome, a 3-fold higher incidence of need for respiratory support at birth and a 10-fold higher incidence of need for intubation compared with cases with non-anomalous late-onset FGR. Such information is important for parental counseling in pregnancies complicated by anomalous late-onset FGR.
Placental insufficiency is associated with reduced oxygen and nutrient supply to the fetus, which may result in fetal growth restriction (FGR). In an attempt to cope with the hostile intrauterine environment, FGR fetuses respond through metabolic, endocrine, vascular, cardiac, behavioral, hematological, and immunological adaptive mechanisms. However, permanent sequelae may result from such adaptive mechanisms. In this review, we describe the mechanisms of fetal adaptation to the hostile intrauterine environment in FGR of uteroplacental origin and detail their pathophysiology and potential implications for the extrauterine life of the individual.
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