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Failure of growth of fetal right cardiac ventricle — Clinical Guidelines

Overview

Fetal right cardiac ventricle failure, particularly in the context of fetal growth restriction (FGR), refers to impaired growth and function of the right ventricle, often indicative of broader cardiovascular compromise and associated with increased perinatal risks 4 13.

Diagnosis

Key Diagnostic Criteria: FGR defined by estimated fetal weight below the 10th percentile or abdominal circumference below the 10th percentile 4 17.

Recommended Tests:

- Ultrasound Assessment: Regular fetal growth ultrasounds to monitor biometric parameters 4 17. - Doppler Studies: Umbilical artery Doppler to assess placental function 21.

Grading: Severity often assessed by combining biometric parameters with Doppler findings 20.

Management

First-Line Interventions:

- Close Monitoring: Frequent antenatal visits and ultrasounds to track fetal growth and well-being 4. - Maternal Optimisation: Manage maternal conditions (e.g., hypertension, diabetes) to optimize placental function 4.

Adjunctive Treatments:

- No Established Prenatal Therapy: Currently, no specific prenatal therapy is universally established 9. - Consideration of Delivery Timing: Based on clinical judgment, Doppler findings, and gestational age 21.

Special Populations

Pregnancy Comorbidities: Management strategies may vary in pregnancies complicated by maternal obesity or vitamin D deficiency, requiring tailored monitoring and interventions 12 14.

Postnatal Considerations: Long-term monitoring for pulmonary and neurodevelopmental impairments in affected neonates 6.

Key Recommendations

Screen for FGR Regularly: Use ultrasound to monitor fetal growth parameters at regular intervals 4 17 (Evidence: Strong).

Assess Placental Function: Incorporate umbilical artery Doppler studies to evaluate placental perfusion 21 (Evidence: Moderate).

Optimize Maternal Health: Manage maternal conditions to potentially improve placental function and fetal growth 4 (Evidence: Moderate).

Consider Timing of Delivery: Base delivery timing on clinical assessment, Doppler findings, and gestational age, considering individual patient circumstances 21 (Evidence: Expert opinion).

References

1 Villalaín C, Herraiz I, Akolekar R, Figueras F, Crispi F, Rizzo G et al.. Clinical practice guidance for the management of fetal growth restriction: an expert review. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 2025. link 2 Rodriguez-Sibaja MJ, Lopez-Diaz AJ, Valdespino-Vazquez MY, Acevedo-Gallegos S, Amaya-Guel Y, Camarena-Cabrera DM et al.. Placental pathology lesions: International Society for Ultrasound in Obstetrics and Gynecology vs Society for Maternal-Fetal Medicine fetal growth restriction definitions. American journal of obstetrics & gynecology MFM 2024. link 3 Koorn I, Heinrich H, Nelissen A, Denswil N, Linskens IH, Jansen CHJR et al.. Isolated fetal umbilical vein varix and the association with intrauterine fetal death and fetal growth restriction: A systematic review, meta-analysis, and nested retrospective cohort study. Prenatal diagnosis 2024. link 4 Kingdom J, Ashwal E, Lausman A, Liauw J, Soliman N, Figueiro-Filho E et al.. Guideline No. 442: Fetal Growth Restriction: Screening, Diagnosis, and Management in Singleton Pregnancies. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC 2023. link 5 Pauta M, Martinez-Portilla RJ, Meler E, Otaño J, Borrell A. Diagnostic yield of exome sequencing in isolated fetal growth restriction: Systematic review and meta-analysis. Prenatal diagnosis 2023. link 6 Valenzuela I, Regin Y, Gie A, Basurto D, Emam D, Scuglia M et al.. Long-term pulmonary and neurodevelopmental impairment in a fetal growth restriction rabbit model. Scientific reports 2023. link 7 Powel JE, Zantow EW, Bialko MF, Farley LG, Lawlor ML, Mullan SJ et al.. Predictive index for adverse perinatal outcome in pregnancies complicated by fetal growth restriction. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 2023. link 8 Giouleka S, Tsakiridis I, Mamopoulos A, Kalogiannidis I, Athanasiadis A, Dagklis T. Fetal Growth Restriction: A Comprehensive Review of Major Guidelines. Obstetrical & gynecological survey 2023. link 9 Valenzuela I, Kinoshita M, van der Merwe J, Maršál K, Deprest J. Prenatal interventions for fetal growth restriction in animal models: A systematic review. Placenta 2022. link 10 Duhig K, Myers J. Detecting fetal growth restriction with customised assessment: Is the jury still out?. PLoS medicine 2022. link 11 Michaeli J, Michaeli O, Rozitzky A, Grisaru-Granovsky S, Feldman N, Srebnik N. Application of Prospect Theory in Obstetrics by Evaluating Mode of Delivery and Outcomes in Neonates Born Small or Appropriate for Gestational Age. JAMA network open 2022. link 12 Zhang Q, Zhang C, Wang Y, Zhao J, Li H, Shen Q et al.. Relationship of maternal obesity and vitamin D concentrations with fetal growth in early pregnancy. European journal of nutrition 2022. link 13 . Fetal Growth Restriction: ACOG Practice Bulletin, Number 227. Obstetrics and gynecology 2021. link 14 Melamed N, Baschat A, Yinon Y, Athanasiadis A, Mecacci F, Figueras F et al.. FIGO (international Federation of Gynecology and obstetrics) initiative on fetal growth: best practice advice for screening, diagnosis, and management of fetal growth restriction. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2021. link 15 Roeckner JT, Pressman K, Odibo L, Duncan JR, Odibo AO. Outcome-based comparison of SMFM and ISUOG definitions of fetal growth restriction. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 2021. link 16 Miura R, Ikeda-Araki A, Ishihara T, Miyake K, Miyashita C, Nakajima T et al.. Effect of prenatal exposure to phthalates on epigenome-wide DNA methylations in cord blood and implications for fetal growth: The Hokkaido Study on Environment and Children's Health. The Science of the total environment 2021. link 17 Blue NR, Beddow ME, Savabi M, Katukuri VR, Mozurkewich EL, Chao CR. A Comparison of Methods for the Diagnosis of Fetal Growth Restriction Between the Royal College of Obstetricians and Gynaecologists and the American College of Obstetricians and Gynecologists. Obstetrics and gynecology 2018. link 18 Wanyonyi SZ, Mutiso SK. Monitoring fetal growth in settings with limited ultrasound access. Best practice & research. Clinical obstetrics & gynaecology 2018. link 19 Razavi AS, Chasen ST. Low PAPP-A: the impact of ultrasound to evaluate fetal growth. Prenatal diagnosis 2016. link 20 Vayssière C, Sentilhes L, Ego A, Bernard C, Cambourieu D, Flamant C et al.. Fetal growth restriction and intra-uterine growth restriction: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians. European journal of obstetrics, gynecology, and reproductive biology 2015. link 21 Burrell SJ, Kingdom JC. The use of umbilical artery Doppler ultrasonography in modern obstetrics. Current opinion in obstetrics & gynecology 1997. link

Failure of growth of fetal right cardiac ventricle