Fetal Development Restriction - Developmental Retardation is a common condition in pregnancy follow-ups and perinatology clinics; It is defined as the fetal weight being lower than the 10th percentile as a result of the evaluation made on ultrasonography. Fetal weight less than the 3rd percentile can also be defined as Severe Fetal Development Restriction. The accuracy of fetal biometric measurements and gestational age is very important in diagnosis. However, true developmental restriction is detected in approximately 30% of these fetuses and is often accompanied by abnormal Doppler findings. In the other 70%, a structurally small fetus is detected. Fetal growth restriction and structurally small fetus are often confused with each other. While fetal growth restriction may be complicated by undesirable situations (such as premature birth, oligohydramnios, lung and neurological diseases in the baby, and death), the structurally small fetus is generally uncomplicated and has a good prognosis.
It is the most important and most common cause. Utero-placental circulatory failure is blamed. Other causes are fetal diseases (genetic disorders, congenital anomalies and intrauterine infections), maternal diseases (chronic hypertension, preeclampsia, diabetes, autoimmune diseases, chronic kidney disease, cyanotic heart disease, hemoglobin optics, smoking, alcohol and drug use, etc.) and placental disorders. (placental infarction, abruption, mosaicism, valemantous cord insertion…) are observed.
The importance of fetal growth restriction; In the fetus, it may be complicated by oligohydramnios, premature birth, and fetal death. Intraventricular hemorrhage, necrotizing enterocolitis, sepsis, hypoglycemia, electrolyte imbalance, hyperviscosity syndrome, neurodevelopmental delay and death are observed more frequently in these newborns and infants. Especially newborns born prematurely and those with severe developmental disabilities are at greater risk. Again, these children and adults may develop neurological developmental delay, cerebral palsy, mental retardation, speech and reading disorders, low learning capacity, chronic diseases (hypertension and diabetes…) and social problems. The development of these complications is rare; birth week, degree of developmental restriction and underlying cause It varies depending on the reasons.
Can fetal growth restriction be prevented? or what are the preventive strategies?
- Risk factors should be evaluated and follow-up planned accordingly. A history of having a baby with developmental disabilities is one of the most important risk factors, and recurrence in the next pregnancy is estimated to be approximately 25%.
- It is important to change the risk factors that can be corrected (quitting smoking or drug use, regulating the existing chronic disease, etc.).
- Uterine artery Doppler is important between 11-14 weeks of pregnancy.
How should a case of suspected fetal growth restriction be evaluated? What should be done?
- Cases with suspected developmental restriction should first be evaluated with a Perinatologist.
- The diagnosis should be confirmed with the correct gestational age and fetal biometry
- Maternal risk factors should be evaluated
- Fetal anatomy, placenta and amniotic fluid should be evaluated
- Fetal and maternal Doppler (blood flow) should be evaluated
- The content and frequency of follow-ups depend on the condition of the fetus. should be customized
- Mother and family should be informed about baby movements and emergencies
Read: 0
