Ultrasound criteria of fetal growth retardation in premature birth





premature birth, fetal growth retardation syndrome, placental dysfunction, fetometry, placentometry, dopplerometry


Purpose - to increase the effectiveness of forecasting and early diagnosis of fetal growth retardation (FGR) in premature pregnancy on the basis of ultrasound examination.

Materials and methods. 165 pregnant women were examined: 30 patients with an uncomplicated pregnancy that ended in physiological timely delivery - the control group (CG); 45 patients with premature birth (PB) (the Group I); 45 women with full-term pregnancy and FGR (the Group II) and 45 patients with PB and FGR (the Group III). Ultrasound examination included serial dynamic fetometry and placentography, dopplerography of vessels of the umbilical cord, ductus venosus, middle cerebral artery and fetal aorta with determination of systolic blood flow velocity and systolic peak velocity of blood flow, systolic-diastolic ratio, index resistance and pulsation index. Statistical processing of research results was carried out using standard programs «Microsoft Excel 5.0» and «Statistica 8.0».

Results. А significant decrease in the parameters of the biparietal size of the fetal head in pregnant women of the Group III was detected at 24-25 weeks of pregnancy: in the CG - 66.4±0.65 mm, in the Group III - 65.02±0.31 mm (p<0.05), in the Group II - 66.2±0.46 mm. A more pronounced slowdown in the rate of growth of the biparietal size of the fetal head was found in pregnant women at 28-29 weeks of gestation, when a significant decrease (p<0.05) in its growth rate was observed in pregnant women of the Groups II and III. The peculiarities of the formation and functioning of the fetoplacental complex in this Groups were characterised by impaired fetal haemodynamics: increase in blood circulation velocity in the venous duct - 74.43±2.24 cm/s vs. 46.54±1.62 cm/s, respectively; p<0.05; increase in pulsatile index in the uterine artery - 1.611±0.04 vs. 1.424±0.07; p<0.05, and in the middle cerebral artery - 1.527±0.02 vs. 1.251±0.03; p<0.005, indicating the tension of subcompensatory reactions.

Conclusions. Ultrasound feto- and placentametry in pregnant women with premature births against the backdrop of FGR showed that in patients with premature births, statistically significant deviations in the size of the fetus and placenta are observed from 24-25 weeks of gestation. Disruption of fetal hemodynamics is indicated by a significant increase in the speed of blood circulation in the ductus venosus in the Groups II and III (74.43±2.24 cm/s vs. 46.54±1.62 cm/s; p<0.05).

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.


American College of Obstetricians and Gynecologists. (2019). ACOG Practice Bulletin No. 204: fetal growth restriction. Obstetrics and gynecology. 133 (2): e97-e109. https://doi.org/10.1097/AOG.0000000000003070; PMid:30681542

Baser E et al. (2020). Abnormal Umblical Artery Doppler is Utilized for Fetuses with Intrauterine Growth Restriction Birth at 280/7-336/7 Gestational Weeks. Fetal and Pediatric Pathology. 39 (6): 467-475. https://doi.org/10.1080/15513815.2020.1716900; PMid:31997690

Brosens I, Puttemans P, Benagiano G. (2019). Placental bed research: I. The placental bed: from spiral arteries remodeling to the great obstetrical syndromes. Am J Obstet Gynecol. 221 (5): 437-456. https://doi.org/10.1016/j.ajog.2019.05.044; PMid:31163132

Derzhavna sluzhba statystyky Ukrainy. (2020). Rozpovsiudzhennia ctatystychnykh vydan Derzhstatu. Derzhavna sluzhba statystyky Ukrainy. URL: http://www.ukrstat.gov.ua.

Care A, Nevitt SJ, Medley N, Donegan S, Good L, Hampson L et al. (2022, Feb 15). Interventions to prevent spontaneous preterm birth in women with singleton pregnancy who are at high risk: systematic review and network meta-analysis. BMJ. 376: e064547. https://doi.org/10.1136/bmj-2021-064547; PMid:35168930 PMCid:PMC8845039

Jin Y, Mankadi PM, Rigotti JI, Cha S. (2018). Cause-specific child mortality performance and contributions to all-cause child mortality, and number of child lives saved during the Millennium Development Goals era: a country-level analysis. Global health action. 11 (1): 1546095. https://doi.org/10.1080/16549716.2018.1546095; PMid:30474513 PMCid:PMC6263110

Kesavan K, Devaskar SU. (2019). Intrauterine growth restriction: postnatal monitoring and outcomes. Pediatric Clinics. 66 (2): 403-423. https://doi.org/10.1016/j.pcl.2018.12.009; PMid:30819345

Lees CC et al. (2020). ISUOG Practice Guidelines: diagnosis and management of small-for-gestational-age fetus and fetal growth restriction. Ultrasound in Obstetrics & Gynecology. 56 (2): 298-312. https://doi.org/10.1002/uog.22134; PMid:32738107

Lees CC et al. (2022). The diagnosis and management of suspected fetal growth restriction: an evidence-based approach. American journal of obstetrics and gynecology. 226 (3): 366-378. https://doi.org/10.1016/j.ajog.2021.11.1357; PMid:35026129 PMCid:PMC9125563

Lemish NY. (2019). Modern methods of great obstetrical syndromes prognostication (literature review). Wiad Lek. 72 (4): 702-706. https://doi.org/10.36740/WLek201904138

Malhotra A et al. (2019). Neonatal morbidities of fetal growth restriction: pathophysiology and impact. Frontiers in endocrinology. 10: 55. https://doi.org/10.3389/fendo.2019.00055; PMid:30792696 PMCid:PMC6374308

Medley N, Vogel JP, Care A, Alfirevic Z. (2018, Nov 14). Interventions during pregnancy to prevent preterm birth: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev. 11 (11): CD012505. https://doi.org/10.1002/14651858.CD012505.pub2; PMid:30480756 PMCid:PMC6516886

Mintser AP. (2018). Statisticheskie metodyi issledovaniya v klinicheskoy meditsine. Prakticheskaya meditsina. 8: 112-118.

Moloney A, Hladunewich M, Manly E, Hui D, Ronzoni S, Kingdom J et al. (2020, Apr). The predictive value of sonographic placental markers for adverse pregnancy outcome in women with chronic kidney disease. Pregnancy Hypertens. 20: 27-35. https://doi.org/10.1016/j.preghy.2020.02.004; PMid:32145525

Nazir Z, Hussain S, Azam M. (2021). Doppler Ultrasound Abnormalities In Intrauterine Growth Restrictions. Pakistan Journal of Medical and Health Sciences. 15 (1): 67-69.

Patel RM. (2016). Short- and Long-term outcomes for extremely preterm infants. American journal of perinatology. 33; 3: 318-328. https://doi.org/10.1055/s-0035-1571202; PMid:26799967 PMCid:PMC4760862

Pels A et al. (2020). Early‐onset fetal growth restriction: A systematic review on mortality and morbidity. Acta obstetricia et gynecologica Scandinavica. 99 (2): 153-166. https://doi.org/10.1111/aogs.13702; PMid:31376293 PMCid:PMC7004054

Safonova YN. (2019). Beremennost vыsokoho ryska: doppler, byofyzycheskyi profyl ploda, fetometryia. Kyev: Medytsyna Ukrayni: 124. ISBN 978-617-7769-01-8.

Salomon LJ et al. (2019). ISUOG Practice Guidelines: ultrasound assessment of fetal biometry and growth. Ultrasound in obstetrics & gynecology. 53 (6): 715-723. https://doi.org/10.1002/uog.20272; PMid:31169958

Shrivastava D, Master A. (2020). Fetal growth restriction. The Journal of Obstetrics and Gynecology of India. 70 (2): 103-110. https://doi.org/10.1007/s13224-019-01278-4; PMid:32255947 PMCid:PMC7109206

SMFM, Martins JG, Biggio JR, Abuhamad A. (2020). Society for Maternal-Fetal Medicine Consult Series# 52: diagnosis and management of fetal growth restriction: (replaces clinical guideline number 3, April 2012). American journal of obstetrics and gynecology. 223 (4): B2-B17. https://doi.org/10.1016/j.ajog.2020.05.010; PMid:32407785

Souza RT, Costa ML, Mayrink J et al. (2020). Perinatal outcomes from preterm and early term births in a multicenter cohort of low risk nulliparous women. Sci Rep. 10: 8508. https://doi.org/10.1038/s41598-020-65022-z; PMid:32444773 PMCid:PMC7244568

Sun C et al. (2020). The placenta in fetal growth restriction: what is going wrong? Placenta. 96: 10-18. https://doi.org/10.1016/j.placenta.2020.05.003; PMid:32421528

Tesfa D et al. (2020). Intrauterine growth restriction and its associated factors in South Gondar zone hospitals, Northwest Ethiopia, 2019. Archives of Public Health. 78 (1): 1-9. https://doi.org/10.1186/s13690-020-00475-2; PMid:33005403 PMCid:PMC7526174

Turcan N et al. (2020). Unfavorable influence of prematurity on the neonatal prognostic of small for gestational age fetuses. Experimental and Therapeutic Medicine. 20 (3): 2415-2422. https://doi.org/10.3892/etm.2020.8744

Vogel JP et al. (2022). Updated WHO recommendations on antenatal corticosteroids and tocolytic therapy for improving preterm birth outcomes. The Lancet. Global health. 10 (12): e1707-e1708. https://doi.org/10.1016/S2214-109X(22)00434-X; PMid:36400080

Wu C, Bayer CL. (2018, Jul 9). Imaging placental function: current technology, clinical needs, and emerging modalities. Phys Med Biol. 63 (14): 14TR01. https://doi.org/10.1088/1361-6560/aaccd9; PMid:29902160

Zur RL, Kingdom JC, Parks WT, Hobson SR. (2020). The Placental Basis of Fetal Growth Restriction. Obstet Gynecol Clin North Am. 47 (1): 81-98. https://doi.org/10.1016/j.ogc.2019.10.008; PMid:32008673