Abstract
Because there is no effective treatment to reverse or stop the progression of placental insufficiency, fetal surveillance and decision regarding when delivery should take place are the main strategies in the management of these fetuses. Although many studies have been conducted, there is a lack of consistent evidence to safely recommend a specific time of delivery in cases of fetal growth restriction (FGR). The objective of a clinical protocol for the management of FGR is to combine the existing evidence on various methods for assessing fetal vitality (cardiotocography, biophysical profile, and Doppler) to achieve better growth and lung maturity and minimize the risk of morbidity as well as fetal and neonatal mortality. A type of management described in the literature is to group patients into stages of development on the basis of the follow-up results, birth time, and similar fetal risks. In this chapter, we will describe a management protocol based on the evidence available in the literature and the characteristics of our practice and of our patient population. A uniform management, based on protocol, improves perinatal outcome, reducing stillbirths.
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References
Seravalli V, Baschat AA. A uniform management approach to optimize outcome in fetal growth restriction. Obstet Gynecol Clin North Am. 2015;42:275–88.
Figueras F, Gardosi J. Intrauterine growth restriction: new concepts in antenatal surveillance, diagnosis, and management. Intrauterine growth restriction: new concepts in antenatal surveillance, diagnosis, and management. Am J Obstet Gynecol. 2011;204:288–300.
Thornton JG, Hornbuckle J, Vail A, Spiegelhalter DJ, Levene M. GRIT study group. Infant wellbeing at 2 years of age in the Growth Restriction Intervention Trial (GRIT): multicentred randomised controlled trial. Lancet. 2004;364:513–20.
Walker DM, Marlow N, Upstone L, Gross H, Hornbuckle J, Vail A, et al. The Growth Restriction Intervention Trial: long-term outcomes in a randomized trial of timing of delivery in fetal growth restriction. Am J Obstet Gynecol. 2011;204:34.e1–9.
Visser GHA, Bilardo CM, Derks JB, Ferrazzi E, Fratelli N, Frusca T, et al. Fetal monitoring indications for delivery and 2-year outcome in 310 infants with fetal growth restriction delivered before 32 weeks’ gestation in the TRUFFLE study. Ultrasound Obstet Gynecol. 2017;50:347–52.
Boers KE, Vijgen SM, Bijilenga D, van der Post JA, Bekedam DJ, Kwee A, et al. Induction versus expectant monitoring for intrauterine growth restriction at term: randomised equivalence trial (DIGITAT). BMJ. 2010;341:c7087.
Pilliod RA, Page JM, Sparks TN, Caughey AB. The growth-restricted fetus: risk of mortality by each additional week of expectant management. J Matern Fetal Neonatal Med. 2017;3:1–6. https://doi.org/10.1080/14767058.2017.1381904.
Rabinovich A, Tsemach T, Novack L, Mazor M, Rafaeli-Yehudai T, Staretz-Chacham O, et al. Late preterm and early term: when to induce a growth restricted fetus? A population-based study. J Matern Fetal Neonatal Med. 2018;31:926–32.
Baschat AA. Integrated fetal testing in growth restriction: combining multivessel Doppler and biophysical parameters. Ultrasound Obstet Gynecol. 2003;21:1–8.
Figueras F, Gratacós E. Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol. Fetal Diagn Ther. 2014;36:86–98.
Nardozza LM, Caetano AC, Zamarian AC, Mazzola JB, Silva CP, Marçal VM, et al. Fetal growth restriction: current knowledge. Arch Gynecol Obstet. 2017;295:1061–77.
Figueras F, Gratacos E. Stage-based approach to the management of fetal growth restriction. Prenat Diagn. 2014;34:655–9.
Arias F. Accuracy of the middle-cerebral-to-umbilical-artery resistance index ratio in the prediction of neonatal outcome in patients at high risk for fetal and neonatal complications. Am J Obstet Gynecol. 1994;171:1541–5.
Cruz-Martinez R, Savchev S, Cruz-Lemini M, Mendez A, Gratacos E, Figueras F. Clinical utility of third-trimester uterine artery Doppler in the prediction of brain hemodynamic deterioration and adverse perinatal outcome in small-for-gestational-age fetuses. Ultrasound Obstet Gynecol. 2014;45:273–8.
Figueras F, Caradeux J, Crispi F, Eixarch E, Peguero A, Gratacos E. Diagnosis and surveillance of late-onset fetal growth restriction. Am J Obstet Gynecol. 2018;218:S790–S802.e1.
Gordijn SJ, Beune IM, Thilaganathan B, Papageorghiou A, Baschat AA, Baker PN, et al. Consensus definition of fetal growth restriction: a Delphi procedure. Ultrasound Obstet Gynecol. 2016;48:333–9.
Cosmi E, Ambrosini G, D’Antona D, Saccardi C, Mari G. Doppler, cardiotocography, and biophysical profile changes in growth-restricted fetuses. Obstet Gynecol. 2005;106:1240–5.
Baschat AA, Cosmi E, Bilardo CM, Wolf H, Berg C, Rigano S, et al. Predictors of neonatal outcome in early-onset placental dysfunction. Obstet Gynecol. 2007;109:253–61.
Nabhan AF, Abdelmoula YA. Amniotic fluid index versus single deepest vertical pocket as a screening test for preventing adverse pregnancy outcome. Cochrane Database Syst Rev. 2008;3:CD006593.
Chauhan SP, Sanderson M, Hendrix NW, Magann EF, Devoe LD. Perinatal outcome and amniotic fluid index in the antepartum and intrapartum periods: a meta-analysis. Am J Obstet Gynecol. 1999;181:1473–8.
Committee on Obstetric Practice. Antenatal corticosteroid therapy for fetal maturation. Committee opinion no. 713. Obstet Gynecol. 2017;130:e102–9.
Saccone G, Berghella V. Antenatal corticosteroids for maturity of term or near term fetuses: systematic review and meta-analysis of randomized controlled trials. BMJ. 2016;355:i5044.
Ting JY, Kingdom JC, Shah PS. Antenatal glucocorticoids, magnesium sulfate, and mode of birth in preterm fetal small for gestational age. Am J Obstet Gynecol. 2018;218:S818–28.
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Caetano, A.C.R., Nardozza, L.M.M. (2019). Obstetric Management. In: Nardozza, L., Araujo Júnior, E., Rizzo, G., Deter, R. (eds) Fetal Growth Restriction. Springer, Cham. https://doi.org/10.1007/978-3-030-00051-6_12
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DOI: https://doi.org/10.1007/978-3-030-00051-6_12
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