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Pathophysiology of Fetal Growth Restriction: Implications for Diagnosis and Surveillance

Baschat, Ahmet Alexander MD

Obstetrical & Gynecological Survey: August 2004 - Volume 59 - Issue 8 - p 617-627
doi: 10.1097/01.OGX.0000133943.54530.76

Normal fetal growth depends on the genetically predetermined growth potential and is modulated by fetal, placental, maternal, and external factors. Fetuses with intrauterine growth restriction (IUGR) are at high risk for poor short- and long-term outcome. Although there are many underlying etiologies, IUGR resulting from placental insufficiency is most relevant clinically because outcome could be altered by appropriate diagnosis and timely delivery. A diagnostic approach that aims to separate IUGR resulting from placental disease from constitutionally small fetuses and those with other underlying etiologies (e.g., aneuploidy, viral infection, nonaneuploid syndromes) needs to integrate multiple imaging modalities. In placental-based IUGR, cardiovascular and behavioral responses are interrelated with the disease severity. Ultrasound assessment of fetal anatomy, amniotic fluid volume, and growth is complementary to the Doppler investigation of fetoplacental blood flow dynamics. A diagnostic approach to IUGR combining these modalities is presented in this review.

Target Audience: Obstetricians & Gynecologists, Family Physicians

Learning Objectives: After completion of this article, the reader should be able to describe the development of the placental interface, to outline the mechanisms of placental insufficiency, and to list the manifestations of placental insufficiency and the tests that can be used to diagnose fetal growth restriction.

Clinical Instructor, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland, Baltimore, Maryland

Chief Editor’s Note: This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA/PRA category 1 credit hours can be earned in 2004. Instructions for how CME credits can be earned appear on the last page of the Table of Contents.

Reprint requests to: Ahmet Alexander Baschat, MD, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland, Baltimore, 405 West Redwood Street, 4th Floor, Baltimore, MD 21201. E-mail:

The author has disclosed no significant financial or other relationship with any commercial entity.

© 2004 Lippincott Williams & Wilkins, Inc.