fetal growth restriction

• related: OBGYN

• pt: ultrasound-estimated fetal weight <10th percentile for gestational age
• cause: increased umbilical artery resistance
  • symmetric:
    • entire fetus affected
    • first trimester
    • Chromosomal abnormalities, infection (eg, cytomegalovirus, toxoplasmosis)
  • asymmetric:
    • head sparing (blood redistribute to brain and away from abd)
    • 2nd/3rd trimester
    • maternal comorbidities (eg, renal disease, hypertension, diabetes mellitus), and multiple gestation
• sx:
  • placental insufficiency that impedes normal fetal growth.
  • fetal hypoxia
  • preterm delivery
• management:
  • Screening serial umbilical artery Doppler sonography and biophysical profiles to evaluate for worsening placental insufficiency and the development of fetal hypoxia
  • Growth measurements are performed every 3-4 weeks.
  • Absent or reversed umbilical artery end-diastolic flow suggests placental insufficiency and impending fetal hypoxia, particularly with concomitant oligohydramnios, and is an indication for delivery.