Fetal growth restriction (retardation): everything the practitioner should know


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The paper reviews international clinical recommendations, practical guidelines, and the results of modern evidence-based researches into fetal growth restriction (retardation) (FGR) as one of the main causes of fetal hypoxic complications and perinatal death. It provides evidence that it is necessary to early form a group of pregnant women at high risk for this complication in order to use preventive treatment and describes the prognostic abilities of maternal, biochemical, and biophysical markers and the combined algorithms introduced into clinical practice in our country. The paper describes in detail the novel diagnostic criteria for early- and late-onset FGR, which are common to the whole world, the reference ranges for fetometric parameters and estimated fetal weight in the international INTERGROWTH-21st Project, which are recommended by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG). The paper publishes the reference ranges for uterine and umbilical artery pulsatility indices and cerebroplacental ratio, which have been obtained using the results of large-scale European studies and Fetal Medicine Foundation ones. It also presents a stage-based algorithm for the monitoring of FGR cases: the frequency of Doppler measurements, the number of evaluated vessels, and criteria of normality for computerized cardiotocography according to the duration of pregnancy and the presence of preeclampsia, by determining indications for delivery and choosing its method. Conclusion. The introduction of modern predictive algorithms, effective prevention methods, unified diagnostic criteria, and the principles of management of FGR cases, which are based on the results of studies with a high reliable level of evidence, into daily clinical practice will be the basis for a considerable reduction in perinatal morbidity and mortality rates.

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Sobre autores

Tamara Yarygina

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Email: tamarayarygina@gmail.com
MD, Ultrasound and Functional Diagnostics Department, Radiology Division

Alexandr Gus

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Email: a_gus@oparina4.ru
MD, Doctor of Medicine, Professor, the Head of Ultrasound and Functional Diagnostics Department, Radiology Division

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