Clasificación del CIR

Francesc Figueras
MANEJO DEL CRECIMIENTO FETAL RESTRINGIDO

Paso 1: Detectar al feto pequeño

Paso 2: Clasificar al feto pequeño

¿Qué hace que un feto pequeño sea RCIU?

 Severidad

Umbilical

FGR
Uterina

Doppler cerebral
 The risk of intrauterine fetal death in the SGA fetus.
Pilliod. Am J Obstet Gynecol 2012.
N=3.4 M Deliveries
70

60
Stillbirths/10 000

50

40 <p3
<p10
<3rd percentile
30 <10rd percentile

20

10

0
24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41
 Estimated weight centile as a predictor of perinatal outcome in small-
forgestational-age fetuses with normal umbilical, brain and uterine
Doppler. Savchev S, Ultrasound Obstet Gynecol 2011

132 SGA>37 semanas: normal UA, MCA & UtA Doppler

% ≥
<
 Severidad

Umbilical

FGR
Uterina

Doppler cerebral
 Emergent CS

Induction of labor

Antenatal admission

Perinatal mortality
25

2
0.
0.

Odds Ratio
Westergaard HB. A critical appraisal of the use of umbilical artery Doppler ultrasound in high-risk
pregnancies: use of meta-analyses in evidence-based obstetrics. Ultrasound Obstet Gynecol
2001;17(6):466-76.
8
b

9
 Severidad

Umbilical

FGR
Uterina

Doppler cerebral
Emergence of Late-onset Placental Dysfunction: Relationship to the Change in Uterine Artery
Blood Flow Resistance between the First and Third Trimesters
Llurba E; Am J Perinatol 2013

%
 Abnormal Uterine Doppler in suspected SGA fetuses

Martinez-Portilla RJ. Uterine artery Doppler predictive capacity for adverse outcomes in SGA suspected fetuses:
A systematic review and meta-analysis.
 Abnormal Uterine Doppler in SGA fetuses

Martinez-Portilla RJ. Uterine artery Doppler predictive capacity for adverse outcomes in SGA suspected fetuses:
A systematic review and meta-analysis (In preparation)
 Severidad

Umbilical

FGR
Uterina

Doppler cerebral
 Longitudinal changes in uterine, umbilical and fetal cerebral Doppler indices in late-onset small-
for-gestational age fetuses. Oros D, Ultrasound Obstet Gynecol. 2011

Doppler trends from diagnosis to delivery (n=171 SGA)

0,8 a

0,6
b

0,4 c

0,2
z-values

0
30 32 34 36 38 40
-0,2

-0,4

-0,6

-0,8

-1

-1,2
a

-1,4
b

e
Longitudinal changes in uterine, umbilical and fetal cerebral Doppler
indices in late-onset small-for-gestational age fetuses.
Oros D,
Doppler Ultrasound
trends Obstet
from diagnosis Gynecol.
to delivery 2011
(n=171 SGA)

p0.005
 CPR in suspected SGA
DR
Stillbirth
(6 studies;n=1495)
FP

DR
Adverse outcome
(11 studies;n=2658)
FP

Conde-Agudelo A, Villar J, Kennedy SH, Papageorghiou AT. Predictive accuracy of cerebroplacental ratio for adverse perinatal and
neurodevelopmental outcomes in suspected fetal growth restriction: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2018
An abnormal cerebroplacental ratio (CPR) is predictive of early childhood delayed neurodevelopment in the
setting of fetal growth restriction. Monteith C, Am J Obstet Gynecol 2019 (June)

SGA normal UA (ref) PORTO study

FGR abnormal UA ( ) M o to r
FGR abnormal CPR ( )

Language

3-y Bayley’s test

C o g n it iv e

0 .1 1 10

OR
 Severidad

Umbilical

FGR
Uterina

Doppler cerebral