Human fetal growth is constrained below optimal for perinatal survival

Vasak, Blanka; Koenen, Steven V.; Koster, Maria P. H.; Hukkelhoven, Chantal W.P.M.; Franx, Arie; Hanson, Mark A.; Visser, Gerard H.A.

doi:10.1002/uog.14644

Cited by 115 publications

(134 citation statements)

References 30 publications

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“…There is a rise in the incidence of stillbirth and perinatal mortality with reducing birthweight centiles, even in those with birthweight centile above the 80th [26,71,72]. This fact is consistent with our recent observation of increasing the proportion of low CPR with reducing birthweight centiles, even in those above the 10 th centile (Figure 1) [73].…”

Section: A Model Of Fetal Surveillancesupporting

confidence: 90%

“…Indeed the majority of stillbirths at term occur in AGA fetuses [25][26][27]. A population based cohort study using data from the medical birth registry of Norway, which included 1.9 million singleton births at or beyond 37 weeks' gestation, showed that the proportion of stillbirths whose weight lies above the 10 th centile (i.e.…”

Section: Assessment Of Fetal Growth At Termmentioning

confidence: 99%

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Role of uteroplacental and fetal Doppler in identifying fetal growth restriction at term

Khalil

Thilaganathan

2017

Best Practice & Research Clinical Obstetrics & Gynaecol

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Identification of the fetus at risk of adverse outcome at term is a challenge to both clinicians and researchers alike. Despite the fact that fetal growth restriction (FGR) is a known risk factor for stillbirth, at least two thirds of the stillbirth cases at term are not small for gestational age (SGA) -a commonly used proxy for FGR. However, the majority of SGA fetuses are constitutionally small babies and do not suffer from adverse perinatal outcome. Doppler cerebroplacental ratio (CPR) is emerging as a marker of failure to reach growth potential at term. CPR is an independent predictor of intrapartum fetal distress, admission to the neonatal unit at term, stillbirth, perinatal death and neonatal morbidity. Raised uterine artery Doppler resistance in the third trimester is independently associated with significantly lower birthweight and CPR. The combination of the estimated fetal weight, CPR and uterine Doppler in the third trimester can identify the majority of fetuses at risk of stillbirth. HIGHLIGHTS Despite the fact that fetal growth restriction (FGR) is a known risk factor for stillbirth, the majority of fetuses suffering from stillbirth at term are not small for gestational age. Serial measurements to assess growth velocity, combined with fetal Doppler, are preferable than a single point estimate. The cerebroplacental ratio (CPR) is emerging as a marker of failure to reach growth potential at term  The combination of the estimated fetal weight, CPR and uterine Doppler in the third trimester can identify the majority of fetuses at risk of stillbirth Highlights (for review) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 2 ABSTRACT Identification of the fetus at risk of adverse outcome at term is a challenge to both clinicians and researchers alike. Despite the fact that fetal growth restriction (FGR) is a known risk factor for stillbirth, at least two thirds of the stillbirth cases at term are not small for gestational age (SGA) -a commonly used proxy for FGR. However, the majority of SGA fetuses are constitutionally small babies and do not suffer from adverse perinatal outcome. Doppler cerebroplacental ratio (CPR) is emerging as a marker of failure to reach growth potential at term. CPR is an independent predictor of intrapartum fetal distress, admission to the neonatal unit at term, stillbirth, perinatal death and neonatal morbidity. Raised uterine artery Doppler resistance in the third trimester is independently associated with significantly lower birthweight and CPR. The combination of the estimated fetal weight, CPR and uterine Doppler in the t...

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Section: A Model Of Fetal Surveillancesupporting

confidence: 90%

Section: Assessment Of Fetal Growth At Termmentioning

confidence: 99%

Role of uteroplacental and fetal Doppler in identifying fetal growth restriction at term

Khalil

Thilaganathan

2017

Best Practice & Research Clinical Obstetrics & Gynaecol

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“…A wider range including second-trimester measures could have allowed higher detection, as suggested by another study [12]. We also admit that placental insufficiency may be present in normally growing fetuses [40] but so far there is no consensus on how to define FGR to capture these cases. Finally, we used conditional centiles for longitudinal assessment (that with only two measurements is largely equivalent to growth velocity), but a more complex approach as the one proposed by Deter et al [41] would have resulted in a better performance.…”

Section: Discussionmentioning

confidence: 98%

Longitudinal Assessment of Abdominal Circumference versus Estimated Fetal Weight in the Detection of Late Fetal Growth Restriction

Basuki¹,

Caradeux²,

Eixarch³

et al. 2018

Fetal Diagn Ther

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Objectives: To perform a longitudinal assessment comparison between estimated fetal weight (EFW) and abdominal circumference (AC) in the prediction of late fetal growth restriction (FGR) as opposed to small for gestational age (SGA). Patients and Methods: A cohort of unselected singleton pregnancies scanned at 32^±2 and 37^±1 weeks was created. Longitudinal growth assessment by calculating the conditional AC and conditional EFW was performed, and both parameters were compared for their prediction capacity for late FGR and SGA. Conditional standards set an expected size (EFW or AC) given a first measurement performed earlier. A declining growth was defined as a conditional growth of <10th centile. Results: A total of 938 pregnancies were included. As expected, declining growth between 32^±2 and 37^±1 weeks was associated with late FGR and SGA, but the predictive capacity of both conditional AC and conditional EFW was comparably poor, with detection rates of 28% at a 10% rate of false positives for late FGR. Conclusions: Longitudinal assessment of fetal growth during the third trimester has a low predictive capacity for late FGR, with no differences between conditional AC and conditional EFW.

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“…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 [7]. …”

Section: Introductionmentioning

confidence: 99%

Early onset fetal growth restriction

Dall’Asta

Brunelli

Prefumo

et al. 2017

matern health, neonatol and perinatol

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Fetal growth restriction (FGR) diagnosed before 32 weeks is identified by fetal smallness associated with Doppler abnormalities and is associated with significant perinatal morbidity and mortality and maternal complications. Recent studies have provided new insights into pathophysiology, management options and postnatal outcomes of FGR. In this paper we review the available evidence regarding diagnosis, management and prognosis of fetuses diagnosed with FGR before 32 weeks of gestation.

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Human fetal growth is constrained below optimal for perinatal survival

Abstract: Objective

Cited by 115 publications

References 30 publications

Role of uteroplacental and fetal Doppler in identifying fetal growth restriction at term

Role of uteroplacental and fetal Doppler in identifying fetal growth restriction at term

Longitudinal Assessment of Abdominal Circumference versus Estimated Fetal Weight in the Detection of Late Fetal Growth Restriction

Early onset fetal growth restriction

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