Fetal Growth Restriction: Does an Integrated Maternal Hemodynamic-Placental Model Fit Better?

AbstractIn recent years, a growing interest has arisen regarding the possible relationship between adverse pregnancy outcomes (APOs) and inadequate maternal hemodynamic adaptations to the pregnancy. A possible association between “placental syndromes,” such as preeclampsia (PE) and fetal growth restriction (FGR), and subsequent maternal cardiovascular diseases (CVD) later in life has been reported. The two subtypes of FGR show different pathogenetic and clinical features. Defective placentation, due to a poor trophoblastic invasion of the maternal spiral arteries, is believed to play a central role in the pathogenesis of early-onset PE and FGR. Since placental functioning is dependent on the maternal cardiovascular system, a pre-existent or subsequent cardiovascular impairment may play a key role in the pathogenesis of early-onset FGR. Late FGR does not seem to be determined by a primary abnormal placentation in the first trimester. The pathological pathway of late-onset FGR may be due to a primary maternal cardiovascular maladaptation: CV system shows a flat profile and remains similar to those of non-pregnant women. Since the second trimester, when the placenta is already developed and increases its functional request, a hypovolemic state could lead to placental hypoperfusion and to an altered maturation of the placental villous tree and therefore to an altered fetal growth. Thus, this review focalizes on the possible relationship between maternal cardiac function and placentation in the development of both early and late-onset FGR. A better understanding of maternal hemodynamics in pregnancies complicated by FGR could bring various benefits in clinical practice, improving screening and therapeutic tools.

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Risk stratification for early-onset fetal growth restriction in women with abnormal serum biomarkers: a retrospective cohort study

Scientific Reports ◽

10.1038/s41598-020-78631-5 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

L. Ormesher ◽

L. Warrander ◽

Y. Liu ◽

S. Thomas ◽

L. Simcox ◽

...

Keyword(s):

Fetal Growth ◽

Fetal Growth Restriction ◽

Early Onset ◽

Late Onset ◽

Area Under The Curve ◽

Maternal Serum ◽

Serum Biomarkers ◽

Growth Restriction ◽

Aneuploidy Screening ◽

Internal Validation

AbstractAbnormal maternal serum biomarkers (AMSB), identified through the aneuploidy screening programme, are frequent incidental findings in pregnancy. They are associated with fetal growth restriction (FGR), but previous studies have not examined whether this association is with early-onset (< 34 weeks) or late-onset (> 34 weeks) FGR; as a result there is no consensus on management. The aims of this study were to determine the prevalence and phenotype of FGR in women with AMSB and test the predictive value of placental sonographic screening to predict early-onset FGR. 1196 pregnant women with AMSB underwent a 21–24 week “placental screen” comprising fetal and placental size, and uterine artery Doppler. Multivariable regression was used to calculate a predictive model for early-onset FGR (birthweight centile < 3rd/< 10th with absent umbilical end-diastolic flow, < 34 weeks). FGR prevalence was high (10.3%), however early-onset FGR was uncommon (2.3%). Placental screening effectively identified early-onset (area under the curve (AUC) 0.93, 95% confidence interval (CI) 0.87–1.00), but not late-onset FGR (AUC 0.70, 95% CI 0.64–0.75). Internal validation demonstrated robust performance for detection/exclusion of early-onset FGR. In this cohort, utilisation of our proposed algorithm with targeted fetal growth and Doppler surveillance, compared with universal comprehensive surveillance would have avoided 1044 scans, potentiating significant cost-saving for maternity services.

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First-Trimester Uterine Artery Doppler Analysis in the Prediction of Later Pregnancy Complications

Disease Markers ◽

10.1155/2015/679730 ◽

2015 ◽

Vol 2015 ◽

pp. 1-10 ◽

Cited By ~ 27

Author(s):

Su Lynn Khong ◽

Stefan C. Kane ◽

Shaun P. Brennecke ◽

Fabrício da Silva Costa

Keyword(s):

Fetal Growth ◽

Fetal Growth Restriction ◽

Early Onset ◽

Uterine Artery ◽

Measurement Techniques ◽

First Trimester ◽

Growth Restriction ◽

Waveform Analysis ◽

Future Research ◽

Uterine Artery Doppler

Uterine artery Doppler waveform analysis has been extensively studied in the second trimester of pregnancy as a predictive marker for the later development of preeclampsia and fetal growth restriction. The use of Doppler interrogation of this vessel in the first trimester has gained momentum in recent years. Various measurement techniques and impedance indices have been used to evaluate the relationship between uterine artery Doppler velocimetry and adverse pregnancy outcomes. Overall, first-trimester Doppler interrogation of the uterine artery performs better in the prediction of early-onset than late-onset preeclampsia. As an isolated marker of future disease, its sensitivity in predicting preeclampsia and fetal growth restriction in low risk pregnant women is moderate, at 40–70%. Multiparametric predictive models, combining first-trimester uterine artery pulsatility index with maternal characteristics and biochemical markers, can achieve a detection rate for early-onset preeclampsia of over 90%. The ideal combination of these tests and validation of them in various patient populations will be the focus of future research.

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Assessment of fetal modified myocardial performance index in early‐onset and late‐onset fetal growth restriction

Echocardiography ◽

10.1111/echo.14364 ◽

2019 ◽

Vol 36 (6) ◽

pp. 1159-1164 ◽

Cited By ~ 3

Author(s):

Lina Zhang ◽

Jijing Han ◽

Na Zhang ◽

Zhen Li ◽

Jingjing Wang ◽

...

Keyword(s):

Fetal Growth ◽

Performance Index ◽

Fetal Growth Restriction ◽

Early Onset ◽

Late Onset ◽

Growth Restriction ◽

Myocardial Performance Index ◽

Myocardial Performance

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Can fetal fractions in the cell-free DNA test predict the onset of fetal growth restriction?

Journal of Perinatal Medicine ◽

10.1515/jpm-2020-0010 ◽

2020 ◽

Vol 48 (4) ◽

pp. 395-401

Author(s):

Duygu Adiyaman ◽

Bahar Konuralp Atakul ◽

Melda Kuyucu ◽

Gizem Toklu ◽

Hakan Golbasi ◽

...

Keyword(s):

Fetal Growth ◽

Fetal Growth Restriction ◽

Early Onset ◽

Late Onset ◽

Growth Restriction ◽

Control Groups ◽

Cell Free Dna ◽

Dna Test ◽

Free Dna ◽

And Control

AbstractObjectiveTo investigate the possible predictive value of fetal fraction in the cell-free DNA (cfDNA) test in pregnancies with early- and late-onset fetal growth restriction (FGR).MethodsThis retrospective study comprised 247 women who were screened using the cfDNA test for aneuploidies during the first or second trimester and had deliveries at our institution from January 2016 to December 2019. The fetal fractions of women with early- (n = 14) and late-onset (n = 83) FGR and those with uncomplicated pregnancies (n = 150) were compared.ResultsThe median fetal fractions for the early-onset FGR, late-onset FGR, and control groups were 5.7 [interquartile range (IQR) 2.65], 7 (IQR 5), and 7.35 (IQR 3.65), respectively. The fetal fractions were significantly lower in the early-onset FGR group than in the late-onset FGR and control groups (P = 0.047 and P = 0.037, respectively). There was no difference in fetal fractions between the late-onset FGR and control groups (P = 1.00).ConclusionAs a placenta-related disease, early-onset FGR had lower fetal fractions in the cfDNA test than uncomplicated pregnancies. For clinical use, lower fetal fractions can contribute as a biomarker for screening asymptomatic women for possible placenta-related diseases, such as early-onset FGR. However, more studies are needed to define the “lower” limit.

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The placental component in early-onset and late-onset preeclampsia in relation to fetal growth restriction

Prenatal Diagnosis ◽

10.1002/pd.3872 ◽

2012 ◽

Vol 32 (7) ◽

pp. 632-637 ◽

Cited By ~ 50

Author(s):

Michal Kovo ◽

Letizia Schreiber ◽

Avi Ben-Haroush ◽

Eran Gold ◽

Abraham Golan ◽

...

Keyword(s):

Fetal Growth ◽

Fetal Growth Restriction ◽

Early Onset ◽

Late Onset ◽

Growth Restriction

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First-trimester measurements of the three-dimensional ultrasound placental volume and uterine artery Doppler in early- and late-onset fetal growth restriction

The Journal of Maternal-Fetal & Neonatal Medicine ◽

10.1080/14767058.2018.1497601 ◽

2018 ◽

Vol 33 (4) ◽

pp. 564-569 ◽

Cited By ~ 2

Author(s):

Tatsuya Arakaki ◽

Junichi Hasegawa ◽

Masamitsu Nakamura ◽

Hiroko Takita ◽

Shoko Hamada ◽

...

Keyword(s):

Fetal Growth ◽

Fetal Growth Restriction ◽

Uterine Artery ◽

Late Onset ◽

Three Dimensional ◽

First Trimester ◽

Growth Restriction ◽

Uterine Artery Doppler ◽

Placental Volume

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Placental Pathology in Early-Onset and Late-Onset Fetal Growth Restriction

Fetal Diagnosis and Therapy ◽

10.1159/000359969 ◽

2014 ◽

Vol 36 (2) ◽

pp. 117-128 ◽

Cited By ~ 123

Author(s):

William Mifsud ◽

Neil J. Sebire

Keyword(s):

Fetal Growth ◽

Fetal Growth Restriction ◽

Early Onset ◽

Late Onset ◽

Growth Restriction ◽

Placental Pathology

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First trimester uterine artery Doppler screening in the prediction of adverse pregnancy outcomes

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20213864 ◽

2021 ◽

Vol 10 (10) ◽

pp. 3933

Author(s):

Jacqueline A. Jayson ◽

Kavita Mandrelle ◽

Tapasya Dhar ◽

Subhash Singla

Keyword(s):

Fetal Growth ◽

Pregnancy Outcomes ◽

Fetal Growth Restriction ◽

Pulsatility Index ◽

Uterine Artery ◽

First Trimester ◽

Adverse Pregnancy Outcomes ◽

Growth Restriction ◽

Uterine Artery Doppler ◽

Adverse Pregnancy

Background: Uterine artery Doppler waveform has been extensively studied as a predictive marker for the later development of preeclampsia and fetal growth restriction. Therefore, uterine artery doppler has emerged as a good test for the prediction of preeclampsia, being simple to perform, reproducible and non-invasive. The present study was done to evaluate the first trimester uterine artery Doppler in the prediction of adverse pregnancy outcome.Methods: This was a prospective cohort study for all pregnant women attending antenatal clinic during 11-14 weeks of gestation at Christian medical college and hospital, Ludhiana, during a period of 18 months. Study population of (n~270) was taken. A pre-designed case record was filled at the time of registration. After taking informed consent, these women underwent ultrasound for uterine artery Doppler pulsatility index along with nuchal translucency & nasal bone scan by transabdominal ultrasound. Patients were followed up throughout the gestation to find out the development of any adverse pregnancy outcomes (early onset preeclampsia, early onset fetal growth restriction, late onset preeclampsia, late onset fetal growth restriction, oligohydramnios, placental abruption and stillbirth).Results: In our study, about 75% of antenatal women were found to have normal first trimester uterine artery pulsatility index and the rest 25% had abnormal pulsatility index. About 40% of women with abnormal dopplers developed complications associated to hypertensive disorders and adverse pregnancy outcomes, while 60% went on to have a normal pregnancy. It was observed that 13.2% developed gestational hypertension, 10.29% developed pulmonary embolism, 1.47% developed eclampsia, 22.05% developed oligohydramnios, 42.64% developed fetal growth restriction, 4.41 % developed placental abruption and 5.88% delivered stillbirth neonates.Conclusions: As hypertensive disorders of pregnancy pose a great risk of maternal and fetal morbidity and mortality, an evolution of Doppler studies have proven to be beneficial. Doppler ultrasound was found to be a valuable modality in the evaluation of fetal and placental circulation as well as in the prediction of pregnancy outcomes. According to the receiver operating characteristic curve obtained in our study, sensitivity and specificity of first trimester uterine artery pulsatility index was predictive for pregnancy complications and adverse outcomes.

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A Cut-off Value for Gestational Week at Birth for Better Perinatal Outcomes in Early- and Late-Onset Fetal Growth Restriction

Zeitschrift für Geburtshilfe und Neonatologie ◽

10.1055/a-0882-7425 ◽

2019 ◽

Vol 223 (05) ◽

pp. 289-296

Author(s):

Mehmet Sinan Beksac ◽

Erdem Fadiloglu ◽

Atakan Tanacan ◽

Apostolos Mamopoulos ◽

Merve Basol ◽

...

Keyword(s):

Fetal Growth ◽

Fetal Growth Restriction ◽

Early Onset ◽

Late Onset ◽

Perinatal Outcomes ◽

Expectant Management ◽

Growth Restriction ◽

Apgar Scores ◽

First Choice ◽

Gestational Week

Abstract Objective Prediction of cut-off value for gestational week at birth for better perinatal outcomes in early- and late-onset fetal growth restriction (FGR). Materials and Methods This study consists of 83 singleton pregnancies with FGR that were diagnosed antenatally and confirmed postnatally between January 2017–April 2018. We used the 34th gestational week as a cut-off for early- and late-onset FGR discrimination. Results Early- and late-onset FGRs were detected in 22 (26.5%) and 61 (73.5%) of the cases, respectively. Expectant management significantly improved birth weight and Apgar scores at the 1st, 5th, and 10th minute in early-onset FGR cases (p=0.001, p=0.019, p=0.002, and p=0.001,respectively). Similar analysis revealed no significant improvements in late-onset FGR (p=0.151, p=0.727, p=0.951 and p=0.477, respectively). Umbilical cord blood gas pH was found to be similar between management modalities in both the early- and late-onset groups (p=0.186 and p=0.456, respectively). Gestational week 33.5 was found to be the threshold for better Apgar scores at the 1st, 5th, and 10th minute according to ROC curve analysis. Percentiles of 4.5, 2.5, and 4.5 were cut-off values for better Apgar scores at the 1st, 5th, and 10th minute, respectively. Conclusion Expectant management must be the first choice to improve Apgar scores in early-onset FGR cases, and gestational week 33.5 must be considered as a threshold for delivery. Immediate delivery might be the choice in late-onset FGR in necessary cases. However, etiology-based management and perinatal surveillance might also be considered to improve prematurity-related neonatal complications.

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