Placental insufficiency and fetal growth restriction

Area of Science:

• Perinatology
• Fetal Medicine
• Obstetrics

Background:

• Fetal growth restriction (FGR) is a pathological condition characterized by a reduced rate of fetal growth.
• Uteroplacental dysfunction is the most common cause of late-onset FGR, stemming from insufficient nutrient and oxygen supply.
• Symmetrical FGR requires careful exclusion of fetal chromosomal anomalies, structural abnormalities, and infections.

Purpose of the Study:

• To elucidate the pathophysiology of uteroplacental dysfunction in fetal growth restriction.
• To highlight diagnostic methods for identifying placental compromise.
• To outline management strategies for severe cases of FGR.

Main Methods:

• Review of the pathophysiology of uteroplacental vascular maladaptation.
• Description of diagnostic utility of Doppler ultrasound in assessing fetal and placental circulation.
• Discussion of clinical management based on fetal and placental status.

Main Results:

• Uteroplacental dysfunction leads to increased vascular resistance and reduced placental blood flow.
• Placental underperfusion results in villous damage and decreased capillary bed, increasing placental resistance.
• Doppler assessment of uterine, umbilical, middle cerebral arteries, and ductus venosus reveals characteristic changes.

Conclusions:

• Doppler velocimetry is crucial for diagnosing placental changes associated with FGR.
• Severe FGR cases require careful intrapartum surveillance and may necessitate preterm delivery via Cesarean section.