Fetal growth restriction and stillbirth: Biomarkers for identifying at risk fetuses

Abstract

Fetal growth restriction (FGR) is a major cause of stillbirth, prematurity and impaired neurodevelopment. Its etiology is multifactorial, but many cases are related to impaired placental development and dysfunction, with reduced nutrient and oxygen supply. The fetus has a remarkable ability to respond to hypoxic challenges and mounts protective adaptations to match growth to reduced nutrient availability. However, with progressive placental dysfunction, chronic hypoxia may progress to a level where fetus can no longer adapt, or there may be superimposed acute hypoxic events. Improving detection and effective monitoring of progression is critical for the management of complicated pregnancies to balance the risk of worsening fetal oxygen deprivation in utero, against the consequences of iatrogenic preterm birth. Current surveillance modalities include frequent fetal Doppler ultrasound, and fetal heart rate monitoring. However, nearly half of FGR cases are not detected in utero, and conventional surveillance does not prevent a high proportion of stillbirths. We review diagnostic challenges and limitations in current screening and monitoring practices and discuss potential ways to better identify FGR, and, critically, to identify the “tipping point” when a chronically hypoxic fetus is at risk of progressive acidosis and stillbirth.

Multi-centre deep learning for placenta segmentation in obstetric ultrasound with multi-observer and cross-country generalization

“…A huge effort has been put into researching predictors of these www.nature.com/scientificreports/ conditions, yielding some promising but preliminary results. Biomarkers in the maternal bloodstream have been investigated extensively and an association has been found between certain biomarkers and the development of preeclampsia, impaired fetal growth and stillbirth [16][17][18] . Recently, placental microRNAs coding for genes related to angiogenesis, growth, and immunomodulation have been found to be measurable in maternal blood lending promise to yet another potential source of early detection of placenta-related pathology 19,20 .…”

Fetal Growth Restriction Is Associated with Pregnancy Associated Plasma Protein A and Uterine Artery Doppler in First Trimester

“…Failure of trophoblast invasion during the first half of pregnancy may lead to reduced dilatation of the placental vessels, producing higher persistence. This can be detected by the waveform of the uterine artery, showing an increased pulsatility index (PI) [ 47 , 48 ]. Several studies have shown that already at the first-trimester screening, abnormal uterine artery flow is associated with FGR [ 46 , 49 , 50 , 51 ].…”

Evaluación de los índices biométricos fetales para el diagnóstico del Retardo del Crecimiento Fetal

“…Se definen como fetos con restricción del crecimiento intrauterino (RCIU) a aquellos que no han alcanzado su potencial de crecimiento debido a factores genéticos o ambientales [1]. La RCIU puede ocasionar muerte fetal, prematuridad y deterioro del neurodesarrollo, asociándose con una mayor mortalidad y morbilidad perinatal [1][2]. Su etiología es multifactorial, pero con frecuencia se asocia con disfunción placentaria [2].…”

“…La RCIU puede ocasionar muerte fetal, prematuridad y deterioro del neurodesarrollo, asociándose con una mayor mortalidad y morbilidad perinatal [1][2]. Su etiología es multifactorial, pero con frecuencia se asocia con disfunción placentaria [2].…”