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Minerva Obstetrics and Gynecology 2021 May 05

DOI: 10.23736/S2724-606X.21.04809-7


lingua: Inglese

Pre-eclampsia and late fetal growth restriction

Francesco MARASCIULO 1, 2, Rossana ORABONA 1, 2, Nicola FRATELLI 1, 2, Anna FICHERA 1, 2, Adriana VALCAMONICO 1, 2, Federico FERRARI 1, 2, Franco E. ODICINO 1, 2, Enrico SARTORI 1, 2, Federico PREFUMO 1, 2

1 Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; 2 Division of Obstetrics and Gynaecology, ASST Spedali Civili, Brescia, Italy


There is a strong but complex relationship between fetal growth restriction and pre-eclampsia. According to the International Society for the Study of Hypertension in Pregnancy the co-existence of gestational hypertension and fetal growth restriction identifies pre-eclampsia with no need for other signs of maternal organ impairment. While early-onset fetal growth restriction and pre-eclampsia are often strictly associated, such association becomes looser in the late preterm and term periods. The incidence of pre-eclampsia decreases dramatically from early preterm fetal growth restriction (39-43%) to late preterm fetal growth restriction (9-32%) and finally to term fetal growth restriction (4-7%). Different placental and cardiovascular mechanism underlie this trend: isolated fetal growth restriction has less frequent placental vascular lesions than fetal growth restriction associated with pre-eclampsia; moreover, late preterm and term fetal growth restriction show different patterns of maternal cardiac output and peripheral vascular resistance in comparison with pre-eclampsia. Consequently, current strategies for first trimester screening of placental dysfunction, originally implemented for pre-eclampsia, do not perform well for late-onset fetal growth restriction: the sensitivity of first trimester combined screening for small-for-gestational age newborns delivered at less than 32 weeks is 56-63%, and progressively decreases for those delivered at 32-36 weeks (43-48%) or at term (21-26%). Moreover, while the test is more sensitive for small-forgestational age associated with pre-eclampsia at any gestational age, its sensitivity is much lower for small-for-gestational age without pre-eclampsia at 32-36 weeks (31-37%) or at term (19-23%).

KEY WORDS: Pre-eclampsia; Fetal growth retardation; Placental insufficiency; Ultrasonography, Doppler; Incidence

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