Talk:Abnormal Development - Fetal Growth Restriction

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Note - This sub-heading shows an automated computer PubMed search using the listed sub-heading term. References appear in this list based upon the date of the actual page viewing. Therefore the list of references do not reflect any editorial selection of material based on content or relevance. In comparison, references listed on the content page and discussion page (under the publication year sub-headings) do include editorial selection based upon relevance and availability. (More? Pubmed Most Recent)

Fetal Growth Restriction

<pubmed limit=5>Fetal Growth Restriction</pubmed>

Intrauterine Growth Restriction

<pubmed limit=5>Intrauterine Growth Restriction</pubmed>

2013

A randomised controlled trial comparing standard or intensive management of reduced fetal movements after 36 weeks gestation-a feasibility study

BMC Pregnancy Childbirth. 2013 Apr 16;13(1):95.

Heazell AE, Bernatavicius G, Roberts SA, Garrod A, Whitworth MK, Johnstone ED, Gillham JC, Lavender T.

Abstract

BACKGROUND: Women presenting with reduced fetal movements (RFM) in the third trimester are at increased risk of stillbirth or fetal growth restriction. These outcomes after RFM are related to smaller fetal size on ultrasound scan, oligohydramnios and lower human placental lactogen (hPL) in maternal serum. We performed this study to address whether a randomised controlled trial (RCT) of the management of RFM was feasible with regard to: i) maternal recruitment and retention ii) patient acceptability, iii) adherence to protocol. Additionally, we aimed to confirm the prevalence of poor perinatal outcomes defined as: stillbirth, birthweight <10th centile, umbilical arterial pH <7.1 or unexpected admission to the neonatal intensive care unit. METHODS: Women with RFM >=36 weeks gestation were invited to participate in a RCT comparing standard management (ultrasound scan if indicated, induction of labour (IOL) based on consultant decision) with intensive management (ultrasound scan, maternal serum hPL, IOL if either result was abnormal). Anxiety was assessed by state-trait anxiety index (STAI) before and after investigations for RFM. Rates of protocol compliance and IOL for RFM were calculated. Participant views were assessed by questionnaires. RESULTS: 137 women were approached, 120 (88%) participated, 60 in each group, 2 women in the standard group did not complete the study. 20% of participants had a poor perinatal outcome. All women in the intensive group had ultrasound assessment of fetal size and liquor volume vs. 97% in the standard group. 50% of the intensive group had IOL for abnormal scan or low hPL after RFM vs. 26% of controls (p < 0.01). STAI reduced for all women after investigations, but this reduction was greater in the standard group (p = 0.02). Participants had positive views about their involvement in the study. CONCLUSION: An RCT of management of RFM is feasible with a low rate of attrition. Investigations decrease maternal anxiety. Participants in the intensive group were more likely to have IOL for RFM. Further work is required to determine the likely level of intervention in the standard care arm in multiple centres, to develop additional placental biomarkers and to confirm that the composite outcome is valid.Trial registration ISRCTN07944306.

PMID 23590451

2012

Antenatal surveillance of fetal growth restriction

Obstet Gynecol Surv. 2012 Sep;67(9):554-65. doi: 10.1097/OGX.0b013e31826a5c6f.

Thompson JL, Kuller JA, Rhee EH. Source Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Duke University Medical Center, Durham, NC 27710, USA. Jennifer.l.thompson@dm.duke.edu

Abstract

Fetal growth restriction is a complex problem in modern obstetrics. It is a condition of suboptimal fetal growth based on a genetically predetermined potential and affects approximately 5% to 10% of pregnancies. It is traditionally defined as an estimated fetal weight less than the 10th percentile. Those pregnancies that are affected by growth restriction are associated with increased risk of perinatal morbidity and mortality. Because of this increased risk, these pregnancies are monitored more closely to try to identify those fetuses at the greatest risk of fetal demise and initiate delivery before this critical event. Although the ideal management strategy is still being determined, there are several modalities available to assist in assessment of the growth-restricted fetus. These include the nonstress test test, biophysical profile, and Doppler velocimetry, most commonly of the fetal umbilical artery, in addition to sonographic growth assessment. The use of multiple fetal assessment tools may help improve the prediction of adverse outcomes and initiate delivery before cardiovascular collapse.

PMID 22990459

Regimens of fetal surveillance for impaired fetal growth

Cochrane Database Syst Rev. 2012 Jun 13;6:CD007113. doi: 10.1002/14651858.CD007113.pub3.

Grivell RM, Wong L, Bhatia V. Source Discipline of Obstetrics and Gynaecology, The University of Adelaide, Women’s and Children’s Hospital, Adelaide, Australia. rosalie.grivell@adelaide.edu.au

Abstract

BACKGROUND: Policies and protocols for fetal surveillance in the pregnancy where impaired fetal growth is suspected vary widely, with numerous combinations of different surveillance methods. OBJECTIVES: To assess the effects of antenatal fetal surveillance regimens on important perinatal and maternal outcomes. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (29 February 2012). SELECTION CRITERIA: Randomised and quasi-randomised trials comparing the effects of described antenatal fetal surveillance regimens. DATA COLLECTION AND ANALYSIS: Review authors R Grivell and L Wong independently assessed trial eligibility and quality and extracted data. MAIN RESULTS: We included one trial of 167 women and their babies. This trial was a pilot study recruiting alongside another study, therefore, a separate sample size was not calculated. The trial compared a twice-weekly surveillance regimen (biophysical profile, nonstress tests, umbilical artery and middle cerebral artery Doppler and uterine artery Doppler) with the same regimen applied fortnightly (both groups had growth assessed fortnightly). There were insufficient data to assess this review's primary infant outcome of composite perinatal mortality and serious morbidity (although there were no perinatal deaths) and no difference was seen in the primary maternal outcome of emergency caesarean section for fetal distress (risk ratio (RR) 0.96; 95% confidence interval (CI) 0.35 to 2.63). In keeping with the more frequent monitoring, mean gestational age at birth was four days less for the twice-weekly surveillance group compared with the fortnightly surveillance group (mean difference (MD) -4.00; 95% CI -7.79 to -0.21). Women in the twice-weekly surveillance group were 25% more likely to have induction of labour than those in the fortnightly surveillance group (RR 1.25; 95% CI 1.04 to 1.50). AUTHORS' CONCLUSIONS: There is limited evidence from randomised controlled trials to inform best practice for fetal surveillance regimens when caring for women with pregnancies affected by impaired fetal growth. More studies are needed to evaluate the effects of currently used fetal surveillance regimens in impaired fetal growth. Update of Cochrane Database Syst Rev. 2009;(1):CD007113.

PMID 22696366

2011

The intrauterine growth restriction phenotype: fetal adaptations and potential implications for later life insulin resistance and diabetes

Semin Reprod Med. 2011 May;29(3):225-36. doi: 10.1055/s-0031-1275516. Epub 2011 Jun 27.

Thorn SR, Rozance PJ, Brown LD, Hay WW Jr. Source University of Colorado School of Medicine, Aurora, Colorado, USA. Abstract The intrauterine growth restricted (IUGR) fetus develops unique metabolic adaptations in response to exposure to reduced nutrient supply. These adaptations provide survival value for the fetus by enhancing the capacity of the fetus to take up and use nutrients, thereby reducing the need for nutrient supply. Each organ and tissue in the fetus adapts differently, with the brain showing the greatest capacity for maintaining nutrient supply and growth. Such adaptations, if persistent, also have the potential in later life to promote nutrient uptake and storage, which directly lead to complications of obesity, insulin resistance, reduced insulin production, and type 2 diabetes. © Thieme Medical Publishers.

PMID 21710398