Prenatal Ultrasound Diagnosis of Biometric changes in the Brain of Growth Restricted Fetuses. A Systematic Review of Literature.

Patrícia Isabel Pereira Silva,Miriam Perez

doi:10.1055/s-0041-1730290

Patrícia Isabel Pereira Silva, Miriam Perez

Open Access

https://doi.org/10.1055/s-0041-1730290

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Abstract

Fetal growth restriction (FGR) occurs when the fetus does not reach its intrauterine potential for growth and development as a result of compromise in placental function. It is a condition that affects 5 to 10% of pregnancies and is the second most common cause of perinatal morbidity and mortality. Children born with FGR are at risk of impaired neurological and cognitive development and cardiovascular or endocrine diseases in adulthood. The purpose of the present revision is to perform a literature search for evidence on the detection and assessment by ultrasound of brain injury linked to FGR during fetal life. Using a systematic approach and quantitative evaluation as study methodology, we reviewed ultrasound studies of the fetal brain structure of growth-restricted fetuses with objective quality measures. A total of eight studies were identified. High quality studies were identified for measurement of brain volumes; corpus callosum; brain fissure depth measurements, and cavum septi pellucidi width measurement. A low-quality study was available for transverse cerebellar diameter measurement in FGR. Further prospective randomized studies are needed to understand the changes that occur in the brain of fetuses with restricted growth, as well as their correlation with the changes in cognitive development observed.

Highlights

Fetal growth restriction (FGR) occurs when the fetus does not reach its intrauterine potential for growth and development as a result of compromise in placental function
Routine two-dimensional (2D) ultrasound was used for fetal biometries, and Doppler measurements and three-dimensional (3D) ultrasound þ virtual organ computer-aided analysis (VOCAL) mode were used for measurement of brain volume
Routine two-dimensional (2D) ultrasound was used for fetal biometries, and Doppler measurements and threedimensional (3D) ultrasound and three-dimensional (3D) ultrasound þ virtual organ computer-aided analysis (VOCAL) mode were used for measurement of brain volume

Summary

Introduction

Fetal growth restriction (FGR) occurs when the fetus does not reach its intrauterine potential for growth and development as a result of compromise in placental function. It is a condition that affects 5 to 10% of pregnancies and is the second most common cause of perinatal morbidity and mortality.[1] The diagnosis of fetal “smallness” is currently performed on the basis of an estimated fetal weight (EFW) below a given threshold, most commonly the 10th percentile.[2] In 2014, Figueras et al.,[2] introduced a new concept of early-onset and late-onset of FGR. Early-onset FGR is typically diagnosed in the second trimester, it is strongly associated with severe placental dysfunction and chronic fetal hypoxia, it presents with preeclampsia in up to 50% of cases and tends to describe the more severe cases of FGR. Evidence accumulating over the last 20 years has consistently demonstrated how being born small has important implications for the quality of health during adulthood, among which are impaired neurological and cognitive development and cardiovascular or endocrine diseases in adulthood.[3,4]

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