Skip to main content
SMFM 2024 Pregnancy Meeting Main banner
Final Program


Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
Additional registration fee required
Additional registration fee required
Faculty have requested this content not be shared on social media
Faculty have requested this content not be shared on social media
CME Credit Offered
CME Credit Offered
Poster Icons
Foundation Awardee
Foundation Awardee
No Social Media
No Social Media
Back
Q&A

Clinical Obstetrics

Poster Session 2

(514) Etiology of Severe Early-Onset Fetal Growth Restriction: Implications for Prenatal Diagnosis (The Multicenter PERIMETER Study)

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Severe early onset fetal growth restriction (EO-FGR) represents a particularly challenging obstetric cohort. The PERIMETER Study collated prenatal diagnostic, obstetric and neonatal outcome data on all EO-FGR cases, with the objective being to analyze the etiology of these most severe cases.

Study Design: The PERIMETER Study collected all singleton cases of EO-FGR confirmed by ultrasound between 180 and 276wks, at the three largest tertiary referral obstetric hospitals in one city from July 2016 to June 2020. FGR diagnosis was confirmed using electronically-stored ultrasound data, with international Delphi consensus criteria used for diagnosis, including biometry and Doppler data. Data relate to ultrasound parameters determined at the time of initial FGR diagnosis.

Results: The PERIMETER Study included 445 cases of severe EO-FGR. Causes of EO-FGR included: uteroplacental (319, 72%), major structural fetal anomalies (71, 16%), genetic abnormalities (54, 12%) and congenital infection (parvovirus) in 1 (< 1%) case. Aneuploidy (42/54; 78%) was the most common genetic abnormality. FGR diagnosis was made later in pregnancy in uteroplacental cases compared with all other causes (mean 24.5 (SD 2.4) v 22.9 (SD 2.5) weeks’ gestation; p< 0.001). Abdominal circumference (AC) or estimated fetal weight (EFW) < 3rd centile identified the majority of cases from any cause, including uteroplacental (235/319; 74%) and other causes combined (117/126; 93%). Umbilical artery Doppler abnormalities at sentinel scan were less common in cases of structural fetal anomaly or genetic abnormality (20/125, 16%) compared with uteroplacental cause (129/319, 40%) (p< 0.001).

Conclusion: Non-uteroplacental causes account for nearly one-third of all cases of severe EO-FGR, and should therefore be considered in the diagnostic work-up of all such cases. AC or EFW < 3rd centile at initial FGR diagnosis, in particular when combined with reassuring umbilical artery Doppler assessment, should prompt consideration for invasive genetic testing.