Book contents
- Fetal Therapy
- Fetal Therapy
- Copyright page
- Dedication
- Contents
- Contributors
- Foreword
- Section 1: General Principles
- Section 2: Fetal Disease: Pathogenesis and Treatment
- Red Cell Alloimmunization
- Structural Heart Disease in the Fetus
- Fetal Dysrhythmias
- Manipulation of Fetal Amniotic Fluid Volume
- Fetal Infections
- Fetal Growth and Well-being
- Chapter 23 Fetal Growth Restriction: Placental Basis and Implications for Clinical Practice
- Chapter 24 Fetal Growth Restriction: Diagnosis and Management
- Chapter 25 Screening and Intervention for Fetal Growth Restriction
- Chapter 26 Maternal and Fetal Therapy: Can We Optimize Fetal Growth?
- Preterm Birth of the Singleton and Multiple Pregnancy
- Complications of Monochorionic Multiple Pregnancy: Twin-to-Twin Transfusion Syndrome
- Complications of Monochorionic Multiple Pregnancy: Fetal Growth Restriction in Monochorionic Twins
- Complications of Monochorionic Multiple Pregnancy: Twin Reversed Arterial Perfusion Sequence
- Complications of Monochorionic Multiple Pregnancy: Multifetal Reduction in Multiple Pregnancy
- Fetal Urinary Tract Obstruction
- Pleural Effusion and Pulmonary Pathology
- Surgical Correction of Neural Tube Anomalies
- Fetal Tumors
- Congenital Diaphragmatic Hernia
- Fetal Stem Cell Transplantation
- Gene Therapy
- Section III: The Future
- Index
- References
Chapter 25 - Screening and Intervention for Fetal Growth Restriction
from Fetal Growth and Well-being
Published online by Cambridge University Press: 21 October 2019
- Fetal Therapy
- Fetal Therapy
- Copyright page
- Dedication
- Contents
- Contributors
- Foreword
- Section 1: General Principles
- Section 2: Fetal Disease: Pathogenesis and Treatment
- Red Cell Alloimmunization
- Structural Heart Disease in the Fetus
- Fetal Dysrhythmias
- Manipulation of Fetal Amniotic Fluid Volume
- Fetal Infections
- Fetal Growth and Well-being
- Chapter 23 Fetal Growth Restriction: Placental Basis and Implications for Clinical Practice
- Chapter 24 Fetal Growth Restriction: Diagnosis and Management
- Chapter 25 Screening and Intervention for Fetal Growth Restriction
- Chapter 26 Maternal and Fetal Therapy: Can We Optimize Fetal Growth?
- Preterm Birth of the Singleton and Multiple Pregnancy
- Complications of Monochorionic Multiple Pregnancy: Twin-to-Twin Transfusion Syndrome
- Complications of Monochorionic Multiple Pregnancy: Fetal Growth Restriction in Monochorionic Twins
- Complications of Monochorionic Multiple Pregnancy: Twin Reversed Arterial Perfusion Sequence
- Complications of Monochorionic Multiple Pregnancy: Multifetal Reduction in Multiple Pregnancy
- Fetal Urinary Tract Obstruction
- Pleural Effusion and Pulmonary Pathology
- Surgical Correction of Neural Tube Anomalies
- Fetal Tumors
- Congenital Diaphragmatic Hernia
- Fetal Stem Cell Transplantation
- Gene Therapy
- Section III: The Future
- Index
- References
Summary
Fetal growth restriction (FGR) can be defined as the failure of the fetus to meet its genetically predetermined growth potential [1] and is associated with significant fetal and perinatal morbidity and mortality. In addition, there is evidence to suggest a longer-term impact of FGR on childhood neurodevelopmental outcomes [2] and cardiovascular and metabolic diseases that manifest in adulthood [3]. However, predicting FGR is not straightforward and methods for screening and diagnosis are imprecise. In the UK and USA, ultrasound scans in the second half of pregnancy are not performed routinely but targeted at women considered to be at risk for FGR, where high risk is identified by maternal characteristics (including anthropometry and pre-existing disease), the development of complications, or clinical suspicion based on being ‘small for dates’ on physical examination. For practical purposes, FGR may be suspected if biometric measurements are below a given threshold of the distribution in the population, typically <10th, 5th or 3rd centile for gestational age, or if there is a reduction in growth velocity (‘crossing centiles’) from previous scans [4]. The difficulty with using biometry alone is that it does not differentiate between the growth-restricted fetus affected by placental insufficiency, and the healthy, constitutionally small fetus. Therefore, additional measures may be employed to diagnose placental dysfunction, such as Doppler studies of the fetal and uteroplacental circulation, and analysis of maternal serum biomarkers. At present, the only treatment available for FGR is to expedite delivery, but at preterm gestations this can also can cause harm. However, new genomics-based research could help us better understand the etiology of growth restriction and identify more accurate diagnostic biomarkers or potential therapeutic targets. This chapter will focus on current practice in screening for and intervention in FGR and will also consider new developments and the future of the field.
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- Fetal TherapyScientific Basis and Critical Appraisal of Clinical Benefits, pp. 279 - 286Publisher: Cambridge University PressPrint publication year: 2020