Abstract
Fetal growth restriction (FGR) is often the result of placental insufficiency and is characterized by insufficient transplacental transport of nutrients and oxygen. The main underlying entities of placental insufficiency, the pathophysiologic mechanism, can broadly be divided into impairments in blood flow and exchange capacity over the syncytiovascular membranes of the fetal placenta villi. Fetal growth restriction is not synonymous with small for gestational age and techniques to distinguish between both are needed. Placental insufficiency has significant associations with adverse pregnancy outcomes (perinatal mortality and morbidity). Even in apparently healthy survivors, altered fetal programming may lead to long-term neurodevelopmental and metabolic effects. Although the concept of fetal growth restriction is well appreciated in contemporary obstetrics, the appropriate detection of FGR remains an issue in clinical practice. Several approaches have aimed to improve detection, e.g., uniform definition of FGR, use of Doppler ultrasound profiles and use of growth trajectories by ultrasound fetal biometry. However, the role of placental morphometry (placental dimensions/shape and weight) deserves further exploration. This review article covers the clinical relevance of placental morphometry during pregnancy and at birth to help recognize fetuses who are growth restricted. The assessment has wide intra- and interindividual variability with various consequences. Previous studies have shown that a small placental surface area and low placental weight are associated with a slower growth of the fetus. Parameters such as placental surface area, placental volume and placental weight in relation to birth weight can help to identify FGR. In the future, a model including sophisticated antenatal placental morphometry may prove to be a clinically useful method for screening or diagnosing growth restricted fetuses, in order to provide optimal monitoring.
Highlights
The diagnosis of fetal growth restriction (FGR) has for long mainly be based on birth weight below a reference cut-off, most commonly the 10th percentile (p10) (Beune et al, 2018)
In this literature review we focus of the gross examination of the placenta and we aim to give an overview on the possible use of placental morphometry in recognizing fetuses and neonates with growth restriction, independent of their weight
Ultrasound was accurate in identifying lateral or marginal cords Ultrasound examination of the placenta and its maternal blood supply may contribute to the perinatal management of pregnancies with high risk of perinatal morbidity/mortality
Summary
The diagnosis of fetal growth restriction (FGR) has for long mainly be based on birth weight below a reference cut-off, most commonly the 10th percentile (p10) (Beune et al, 2018). Birth weight (BW) or estimated fetal weight (EFW) below p10 indicates that the BW or EFW is within the lowest 10% of BW compared to the reference population This is in essence not FGR but small for gestational age (SGA). FGR overlaps with, but is not synonymous to, SGA (Zhang et al, 2010) (“SGA-FGR confusion”), as two overlapping distribution curves It is self-evident that the incidence of growth restricted fetuses increases as EFW or BW percentiles decreases (Vasak et al, 2015). Severe growth restriction or evidence of placental dysfunction was defined as “growth restricted” (Figueras and Gratacos, 2017)
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