Fetal Growth Restriction (FGR)—Fetal Evaluation and Antepartum Intervention

Abstract

Fetal growth restriction (FGR) is a pathological condition that refers to a fetus that fails to reach his/her genetically predetermined growth potential. By epigenetic effects, substrate and energy deprivation in utero modify fetal metabolism with possible life-long impacts. Management of FGR still represents one of the main challenges for the obstetricians, both for the complexities of management of severe early FGR and for the diagnostic difficulties in late and term FGR. Late onset and term FGR define an intrauterine trajectory of growth that falls below its potential late in gestation, after 34 and 37 weeks of gestation, respectively. Ultrasound biometry examination is crucial for an accurate diagnosis of FGR. Pregnancies at risk of FGR should be considered for longitudinal ultrasound monitoring beyond the routine ultrasound screening at 20 weeks of gestation. Functional assessment of placental and fetal circulation by Doppler velocimetry and blood flow volume, together with computerized assessment of fetal heart rate variability, are key examinations in early and late FGR to assess severity of the disease and monitor fetal wellbeing. Appropriate timing of delivery in early FGR might change the outcome, and appropriate monitoring in late and term FGR might avoid unnecessary interventions.