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Minerva Obstetrics and Gynecology 2021 May 05

DOI: 10.23736/S2724-606X.21.04819-X

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Monitoring fetal well-being in labor in late fetal growth restriction

Andrea DALL’ASTA 1, 2 , Greta CAGNINELLI 1, Letizia GALLI 3, Tiziana FRUSCA 1, Tullio GHI 1

1 Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy; 2 Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, London, UK; 3 Unit of Obstetrics and Gynecology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Unità Sanitaria Locale, Reggio Emilia, Italy


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Late-onset fetal growth restriction (FGR) accounts for approximately 70-80% of all cases of FGR secondary to uteroplacental insufficiency and is associated with an increased risk of adverse antepartum and perinatal events, which in most instances result from hypoxic insults either present at the onset of labour or supervening during labour as a result of uterine contractions. Labour represents a stressful event for the fetoplacental unit being uterine contractions associated with an up-to 60% reduction of the uteroplacental perfusion. Intrapartum fetal heart rate monitoring by means of cardiotocography (CTG) currently represents the mainstay for the identification of fetal hypoxia during labour and is recommended for the fetal surveillance in the case of FGR or other conditions associated with an increased risk of hypoxia during labour. In this review we discuss the potential implications of an impaired placental function on the intrapartum adaptation to the hypoxic stress and the role of the CTG and alternative techniques for the intrapartum monitoring of the fetal wellbeing in the context of FGR secondary to uteroplacental insufficiency.


KEY WORDS: Cardiotocography; STAN; Labour hypoxia; Cerebral redistribution

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