ABSTRACT
DEFINITIONS/DIAGNOSIS FGR is diagnosed when the sonographic EFW is <10th percentile for gestational age on a standardized population growth curve. So both screening and diagnosis of FGR are based on ultrasound biometry, and they rely on accurate dating by an early ultrasound (preferably first trimester). The terms FGR, intrauterine growth restriction (IUGR), and small for gestational age (SGA) are often used interchangeably. However, FGR is the preferred term by the American College of Obstetricians and Gynecologists (ACOG), and it is used in the chapter. Small for gestational age (SGA) is a term used for the neonate [1] and is defined as a birth weight
Table 45.1 Risk Factors Associated with FGR
Maternal Hypertension (20%–30%)
Preeclampsia Chronic hypertension Secondary hypertension
Pregestational diabetes Autoimmune disease Antiphospholipid syndrome Lupus Maternal cardiac disease Congenital heart disease Heart failure Pulmonary disorders
Cystic fibrosis COPD Uncontrolled asthma
Renal disease Chronic renal insufficiency Nephrotic syndrome Chronic renal failure
Gastrointestinal disease Ulcerative colitis Crohn’s disease Malabsorptive disorders Gastric bypass
Toxic exposure Smoking Alcohol Cocaine Stimulants
Malnutrition Living at high altitudes Low socioeconomic status Race Extremes of maternal age
Fetal Genetic diseasesa
Aneuploidya
Fetal malformations (1%–2%) Multiple gestation (3%) Fetal infection (5%–10%)
CMV Toxoplasmosis Rubella Malaria HSV
Placental Abruption
Placental mosaicism Placenta accreta Chorioangioma Implantation abnormalities with abnormal analytes on serum screening
Abbreviations: CMV, cytomegalovirus; COPD, chronic obstructive pulmonary disease; FGR, fetal growth restriction; HSV, herpes simplex virus. aIncidence of genetic diseases or aneuploidy is about 5% to 20%.
