1.15 Early and late onset FGR

The most common cause of FGR is placental disease, which tends to have two main clinical manifestations – early and late (10, 11).​

  • Early onset FGR is often associated with reduced villous cross-sectional vascular area of the placenta which results in a perfusion defect and elevated umbilical artery (UA) blood flow resistance. This type of FGR typically develops in mid-trimester and presents with an SGA fetus and abnormal UA Doppler(12). ​
  • Late onset FGR is more common than early onset disease, develops in the third trimester and is associated with villous immaturity and other pathologies producing a placental diffusion defect where reduction in villous cross-sectional area is often below the threshold detectable by UA Doppler (13). ​

10 – Turan OM, Turan S, Gungor S, Berg C, Moyano D, Gembruch U, Nicolaides KH, Harman CR, Baschat AA. (2008) Progression of Doppler abnormalities in intrauterine growth restriction. Ultrasound Obstet Gynecol; 2008: 32: 160-67.

11 – Groom K, North R, Poppe K, Sadler L, McCowan L. (2007) The association between customised small for gestational age infants and pre-eclampsia or gestational hypertension varies with gestation at delivery. BJOG, 114(4), 478-484. doi:10.1111/j.1471-0528.2007.01277.x

12 – Dall’Asta A, Brunelli V, Prefumo F, Frusca T, Lees C. (2017) Early onset fetal growth restriction. Maternal Health, Neonatology and Perinatology, 3, 2. doi:10.1186/s40748-016-0041-x

13 – Parra-Saavedra M, Crovetto F, Triunfo, S, Savchev S, Peguero A, Nadal A,
Parra, G, Gratacos E, Figuera F. (2013) Placental findings in late-onset SGA births without Doppler signs of placental insufficiency Placenta Volume34, Issue 12, Dec 2013, 1136-1141

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