Ovarian Insufficiency: Surgical Therapy

Management of fetal growth restriction (FGR) in relation to each stage (after).

FGR stage Pathophysiological correlate Criteria (min. 1) Monitoring Delivery
I Mild placental insufficiencyFGR < 3rd percentile.
  • Estimated weight <3rd percentile
  • PI UA > 95th percentile
  • PI ACM < 5th percentile
  • CPR < 5th percentile
 1 x weekly Introduction37. SSW
II severe placental insufficiency
  • UA AEDF
 2 x weekly Sectio caesarea32-34th SSW
III fetal hypoxiaunlikely
  • UA REDF
  • PI DV > 95th percentile
 1-2 days Sectio caesarea30th-32nd SSW
IV fetal hypoxia probable
  • A-wave negative
  • DV STV < 3 ms
  • Decelerations in CTG
 12 hours Sectio caesarea from 26th SSW onwards

Legend

  • PI = pulsatility index (RI value; vascular resistance).
  • UA = umbilical artery (UA).
  • ACM = Arteria cerebri media
  • DV = ductus venosus
  • AEDF = “absent enddiastolic flow”
  • CPR = cerebroplacental ratio.
  • REDF = “reverse enddiastolic flow”
  • STV = “short-time variation”
  • CTG = cardiotocography (heart sound contraction recorder).

See also under “Doppler sonography in gravidity”.

Operative measures

1st order

  • Acute placental insufficiency: depending on the situation:
    • During childbirth: Sectio (cesarean section), vacuum (suction cup), or forceps, according to the obstetric situation.
    • Before the birth: primary sectio
  • Chronic placental insufficiency: depending on the situation, when there is a threat of fetal asphyxia (insufficient oxygen supply to the fetus due to insufficient oxygen supply through the umbilical vein):
    • During childbirth: sectio, vacuum or forceps, according to the obstetric situation.
    • Before the birth: primary sectio