This document discusses fetal growth restriction (FGR), including its risk factors, definition, and methods for monitoring and managing care. It notes that FGR can be caused by maternal, fetal, placental, or external factors. Screening involves distinguishing between small-for-gestational-age (SGA) and FGR babies using ultrasound measurements and Doppler studies of blood flow in key vessels. Abnormal Doppler readings in the umbilical artery, middle cerebral artery, ductus venosus, and aortic isthmus can help stratify risk. Later stages of FGR involve changes like cerebral vasodilation and peripheral vasoconstriction that can be tracked. Management follows a stage-based protocol depending on factors

1. FETALGROWTHRESTRICTION

2. INCIDENCE

3. FGR risk factors
maternal
• idiopathic
• chronic disease
• abnormal implantation
(PE, HELLP, antiphospholipid, FGR
fetal
• chromosomal anomaly
• genetic syndrome
• congenital anomaly
placenta
• mosaicism
• uterine anomaly
• velamentous cord insertion
external factors
• smoking
• infection
• psycho/social
SGA / FGR

4. DEFINITION

5. Correct recognition of SGA and FGR

6. SGA vs FGR

9. Early & Late FGR

11. Doppler velocimetry

12. FGR: Doppler US Studies for Risk Stratification
UtA Doppler US:
ABNORMAL

13. Umbilical artery:

15. MCA:

16. CEREBROPLACENTAL RATIO(CPR)

17. DuctusVenosus Doppler US:

18. •AORTIC ISTHMUS
• Experimental and clinical data support the
incorporation of Doppler flow velocity waveforms
through the aortic isthmus among the
noninvasive markers of fetal well-being
• Because of this unique anatomic position, isthmic
flow velocity waveforms are influenced not only
by downstream impedance of the
subdiaphragmatic circulation but also by changes
in arterial tone in the upper part of the body,
especially the brain.

20. OTHER USEFUL MONITORINGTOOLS
Biophysical profile scoring

21. Cardiotocography and short-term variation

22. Successive and sequential Doppler changes
develop in e-FGR
Cerebral hypoxia
-- cerebral
vasodilatation →
MCA PI
peripheral fetal
vasoconstriction-
increased
resistance in the
umbilical arteries
→ UA PI
Reversal of flow
in aortic isthmus
absent end-
diastolic/ reverse
flow in umbilical
artery
overload of the
precordial venous
system with "a"
wave absent or
negative on
ductus venosus

23. STAGE – BASED MANAGEMENT PROTOCOL

24. L-FGR

27. S
U
M
M
A
R
Y

29. THANKYOU