Restrição do crescimento fetal: elaboração de um protocolo clínico-assistencial

Abstract

Introduction: Fetal growth restriction (FGR) is primarily defined as a failure of the fetus to reach its genetically determined growth potential. This condition should be differentiated from small for gestational age fetuses (SGA), in which the estimated fetal weight (EFW) is below a certain limit, most commonly the 10th percentile. The distinction between the two groups also involves changes in Doppler, which reflect fetal adaptation to a hypoxic intrauterine environment due to increased placental resistance, present in fetuses with FGR. Both are at risk of worse perinatal outcomes, although restricted fetuses have a greater chance of intrauterine fetal deterioration and stillbirth. Identification during prenatal care is crucial for better monitoring, surveillance, and reduction of adverse outcomes. The diagnosis can sometimes be challenging and unknown until birth, even with adequate prenatal care and ultrasound monitoring. This condition, because it presents significant morbidity and mortality, must be adequately identified and managed during prenatal care in order to ensure better fetal surveillance, timely delivery and better perinatal outcomes. Objectives: Develop a clinical care protocol for the Maternity School of Federal University of Rio de Janeiro (UFRJ) on fetal growth restriction. Material and Methods: This is a study with a methodological approach to create a tool to guide care in pregnancies with fetal growth restriction through a care protocol. Conclusion: Because it is a highly relevant topic in obstetric practice, associated with adverse and potentially preventable outcomes, timely diagnosis ensures adequate management of pregnancies affected by fetal growth restriction. There are different recommendations in the current literature regarding the timing of pregnancy termination and also regarding the frequency and forms of management during prenatal care. Thus, the creation of a protocol helps to guide the management of this clinical entity, at the time of diagnosis and during the pregnancy’s monitoring, seeking to improve the prognosis associated with the condition.