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CC BY 4.0 · Am J Perinatol 2025; 42(16): 2187-2190
DOI: 10.1055/a-2573-4517
Original Article

FGR Diagnosis with EFW <10% versus AC <10%: Differences in Clinical Presentation, Pregnancy Outcomes, and Correlation with Placental Lesions of Malperfusion

Autoren

  • Megan Savage

    1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York

  • Luiza Perez

    2   Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York

  • Natalie Nguyen

    2   Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York

  • Stephen Chasen

    3   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York

Funding None.
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Abstract

Objective

This study aimed to identify what biometry is most predictive of placental malperfusion and obstetrical outcomes.

Study Design

Retrospective cohort study comparing pregnancies diagnosed with fetal growth restriction (FGR) from 2018 to 2020. Pregnancies with estimated fetal weight (EFW) < 10th percentile were characterized as the “EFW” group, and those with normal EFW but abdominal circumference (AC) < 10th percentile were characterized as the “AC” group. Mann–Whitney U, Fisher's exact test, and chi-square were used for statistical comparison.

Results

A total of 318 pregnancies were included, with 250 and 68 in EFW and AC groups, respectively. There were no significant differences in demographics between groups. The diagnosis was earlier in the EFW group (33 [30–36] vs. 35 [32–36] weeks; p = 0.001), with a higher proportion diagnosed at < 32 weeks. Delivery was also earlier in the EFW group (37 [35–38] vs. 38 [36–39] weeks; p = 0.01), with a higher rate of delivery <34 weeks compared with the AC group. Diagnosis at < 32 weeks was associated with higher rates of maternal (75.5 vs. 51.4%; p < 0.001) and fetal (25.5 vs. 14.6%; p = 0.02) malperfusion. After initial diagnosis, follow-up ultrasound was not consistent with FGR in 11.0% of cases, and this was more common in the AC group (19.1 vs. 8.7%; p = 0.03). “Resolution” of FGR was associated with lower rates of maternal malperfusion compared with persistent findings of FGR (28.5 vs. 63.3%; p < 0.001).

Conclusion

In the cohort with FGR based on EFW <10th percentile, diagnosis and delivery were earlier. There was also a higher rate of delivery <34 weeks in the EFW group. There were no significant differences in the rate of placental lesions of maternal or fetal malperfusion based on diagnostic criteria of FGR however a diagnosis <32 weeks was associated with higher rates of malperfusion. Diagnosis based on small AC was more likely to “resolve” on follow-up and this was associated with lower rates of maternal malperfusion.

Key Points

  • FGR based on EFW <10th percentile, diagnosis and delivery were earlier.

  • FGR diagnosed <32 weeks is associated with higher rates of malperfusion.

  • FGR diagnosis based on small AC was more likely to “resolve” on follow-up.

Keywords

fetal growth restriction - placental pathology - malperfusion - obstetrical outcomes

Ethical Approval

This study was deemed exempt by the Weill Cornell College of Medicine Institutional Review Board (protocol no.: 21–03023463), with a waiver of informed consent.




Publikationsverlauf

Eingereicht: 19. Februar 2025

Angenommen: 24. März 2025

Artikel online veröffentlicht:
30. April 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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