Placenta and trophoblasts II
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Define foetal growth restriction (FGR)
Notoriously difficult to define • Definition is conceptual • Is a condition in which the foetus does not reach its biological growth potential • Often equated to being small • Not all small foetuses are growth restricted • Not all growth restricted foetuses are small
How to measure FGR
Growth involves increment in a time interval • Usual method is to plot fetal size against gestation • Various centile cut-offs are used for diagnosis of SGA Graph can show if the foetus is too large or too small for gestational age
What are the causes of smallness in a foetus
Dating problems • Constitutional • Primary fetal/environmental problem • Placental insufficiency
Chromosomal/genetic reasons for smallness (name conditions)
Chromosomal abnormalities (e.g. Trisomy 18, Triploidy) • Congenital infections (e.g. Rubella, CMV) • Genetic syndromes (e.g. Russell-Silver syndrome) • Teratogens (e.g. Fetal alcohol syndrome, Drug abuse) • Maternal problem (e.g. Cyanotic CHD)
Describe one of the reasons for a foetus being too small: placental insufficiency
Placenta function is nutrient and gas exchange • Poor function will lead to: • Slowing of growth • Hypoxaemia – Hypoxia – Asphyxia • Stillbirth • Ultrasound used to find evidence of • Placental dysfunction • Fetal response to the dysfunction
Potential reasons why placental insufficiency could be a problem (who does it affect)?
Risk factor- eg maternal age, smoking, drug misuse • Previous history- eg. previous still birth or maternal issues such as diabetes, chronic hypertension, previous still birth • Positive uterine arterial Doppler screen • Abnormal placental echo-texture • AC below the 5th centile