Publication Date
3-1-2022
Journal
American Journal of Obstetrics & Gynecology
DOI
10.1016/j.ajog.2021.11.1357
PMID
35026129
PMCID
PMC9125563
PubMedCentral® Posted Date
3-1-2023
PubMedCentral® Full Text Version
Author MSS
Published Open-Access
yes
Keywords
abdominal circumference, cardiotocography, cesarean delivery, Disproportionate Intrauterine Growth Intervention Trial at Term, Doppler velocimetry, ductus venosus, fetal biometry, fetal death, fetal distress, fetal growth, longitudinal, middle cerebral artery, neurodevelopmental outcome, Prospective Observational Trial to Optimize Pediatric Health, randomized controlled trial, short-term variation, small for gestational age, systematic review, umbilical artery Doppler, umbilical artery pH, uterine artery, Trial of Umbilical and Fetal Flow in Europe
Abstract
This study reviewed the literature about the diagnosis, antepartum surveillance, and time of delivery of fetuses suspected to be small for gestational age or growth restricted. Several guidelines have been issued by major professional organizations, including the International Society of Ultrasound in Obstetrics and Gynecology and the Society for Maternal-Fetal Medicine. The differences in recommendations, in particular about Doppler velocimetry of the ductus venosus and middle cerebral artery, have created confusion among clinicians, and this review has intended to clarify and highlight the available evidence that is pertinent to clinical management. A fetus who is small for gestational age is frequently defined as one with an estimated fetal weight ofrestriction, a constitutionally small fetus, congenital infections, chromosomal abnormalities, or genetic conditions. Small for gestational age is not synonymous with fetal growth restriction, which is defined by deceleration of fetal growth determined by a change in fetal growth velocity. An abnormal umbilical artery Doppler pulsatility index reflects an increased impedance to flow in the umbilical circulation and is considered to be an indicator of placental disease. The combined finding of an estimated fetal weight oflate, depending on whether the condition is diagnosed before or after 32 weeks of gestation. The early type is associated with umbilical artery Doppler abnormalities, whereas the late type is often associated with a low pulsatility index in the middle cerebral artery. A large randomized clinical trial indicated that in the context of early suspected fetal growth restriction, the combination of computerized cardiotocography and fetal ductus venosus Doppler improves outcomes, such that 95% of surviving infants have a normal neurodevelopmental outcome at 2 years of age. A low middle cerebral artery pulsatility index is associated with an adverse perinatal outcome in late fetal growth restriction; however, there is no evidence supporting its use to determine the time of delivery. Nonetheless, an abnormality in middle cerebral artery Doppler could be valuable to increase the surveillance of the fetus at risk. We propose that fetal size, growth rate, uteroplacental Doppler indices, cardiotocography, and maternal conditions (ie, hypertension) according to gestational age are important factors in optimizing the outcome of suspected fetal growth restriction.