Читать книгу Protocols for High-Risk Pregnancies - Группа авторов - Страница 78

Once the fetus has been diagnosed by ultrasound to be growth restricted, a full ultrasound assessment of the fetus should be performed to exclude fetal anomalies, possible karyotypic abnormalities, and congenital infection. The dating criteria for the pregnancy should be reviewed and estimated date of confinement confirmed. Early‐onset structural abnormalities or symmetrical FGR should result in consideration of excluding karyotype abnormalities and congenital infection.

Treatment options are limited in FGR and include avoidance of physically strenuous activities and work, increased fluid intake, and elimination of adverse social habits such as tobacco, alcohol or recreational drug use. Societal impact of bedrest is significant with an estimated 800 000 patients annually placed on bedrest leading to loss of work and wages. Bedrest should not be recommended as there is no evidence of benefit and there is risk of harm (thromboembolic disease). Avoidance or reduction of physically demanding work and exercise may be reasonable and the patient’s activity level can be labeled as “modified” rest and customized for the patient. In pregnant patients with a history of FGR due to preeclampsia in a previous pregnancy, a baby aspirin (81 mg) has been shown to have some benefit in reducing the risk of recurrence and should be started in the first half of pregnancy, preferably prior to 16 weeks of gestation.

Surveillance of the growth‐restricted fetus includes the use of fetal activity count, serial assessment of fetal growth with ultrasound (every 3–4 weeks), nonstress test and/or biophysical profile, and Doppler velocimetry. Early‐onset FGR fetuses who deteriorate in utero from an acid–base standpoint often demonstrate sequential Doppler changes in different vessels, while these changes occur far less frequently in late‐onset FGR. Use of Doppler in the management of the FGR fetus is further discussed in Protocol 41.