Early-onset fetal growth restriction.

Introduction. Intrauterine growth restriction (IUGR) affects 5-10% of pregnancies and represents the second cause of perinatal mortality. Early-onset IUGR is usu- ally caused by placental dysfunction, but many other causes may be involved. Case report. We present the case of a 42-year-old woman, IIP, referred for amniocen- tesis for high genetic risk (trisomy 18) revealed by the noninvasive prenatal test (NIPT) for fetal aneuploidies. The amniocentesis performed at 16 weeks and 6 days showed a normal karyotype. A detailed second-trimester anomaly scan was repeated at 22 weeks and confirmed no signs of fetal structural abnormalities, an estimated fetal weight (EFW) at percentile (p) 16, and a pulsatility index (PI) within normal ranges for both uterine arteries and umbilical artery (UA). No signs of an active infec- tion were found at the specific investigations, including extended TORCH complex, and thrombophilia was ruled out. During the following weeks, the fetus developed symmetric IUGR<8th percentile, with normal UA, MCA (middle cerebral artery), and ductus venous (DV) flows. At 30 weeks, the EFW was at percentile 5.2. At 32 weeks, we noticed a deterioration of the fetal well-being with a non- reactive nonstress test, absent end-diastolic flow in UA, but with normal DV Doppler. The patient was admitted for closer surveillance, corticotherapy and magnesium sulfate therapy. The CPR (cerebral-placental ratio) was <5th percentile, and PI-UA was above percentile 95. Two days later, the CPR reversed, the short-term variations on cardiotocography decreased at 3.1 ms, and an 1130 g fetus was delivered by caesarean section, with an Apgar score of 7. Overall, the outcome was favorable, with the newborn discharged after one month. Conclusions. In early-onset IUGR, optimal monitoring and delivery timing are crucial. Doppler scanning (uterine arteries, UA and MCA) and biophysical monitoring help prevent acidemia and stillbirth. Placental mosaicism must be considered in cases where NIPT results are not con- firmed by invasive genetics. [ABSTRACT FROM AUTHOR]