Comparação entre protocolos de acompanhamento da restrição de crescimento fetal

Leal, Caio Ribeiro Vieira; Rezende, Karen Pereira; Macedo, Evilane do Carmo Patrício de; Rezende, Guilherme de Castro; Corrêa Júnior, Mário Dias

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Review Article • Rev Bras Ginecol Obstet 45 (2) • Fev 2023 • https://doi.org/10.1055/s-0043-1764493 copiar

Comparação entre protocolos de acompanhamento da restrição de crescimento fetal

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Esta revisão compreensiva compara protocolos clínicos de entidades importantes em relação ao manejo da restrição de crescimento fetal (RCF), publicados desde 2015. Cinco protocolos foram escolhidos para a extração de dados. Não houve diferenças relevantes quanto ao diagnóstico e classificação da RCF entre os protocolos. Em geral, todos os protocolos sugerem que a avaliação da vitalidade fetal deve ser realizada de forma multimodal, associando parâmetros biofísicos (como cardiotocografia e perfil biofísico fetal) aos parâmetros dopplervelocimétricos da artéria umbilical, artéria cerebral média e ducto venoso. Todos os protocolos reforçam que quanto mais grave a condição fetal, mais frequente essa avaliação deve ser feita. A idade gestacional oportuna e o modo de parto para interromper a gravidez nesses casos podem variar muito entre os protocolos. Portanto, este trabalho apresenta, de forma didática, as particularidades de diferentes protocolos de acompanhamento de RCF, a fim de auxiliar os obstetras no melhor manejo dos casos.

Palavras-chave
Restrição de crescimento fetal; Dopplervelocimetria; Prematuridade; Cardiotocografia; Protocolos

	FIGO¹1 Melamed N, Baschat A, Yinon Y, 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. Int J Gynaecol Obstet. 2021;152(01):3–57. Doi: 10.1002/ijgo.13522 https://doi.org/10.1002/ijgo.13522...	ISUOG²2 Lees CC, Stampalija T, Baschat A, et al. ISUOG Practice Guidelines: diagnosis and management of small-for-gestational-age fetus and fetal growth restriction. Ultrasound Obstet Gynecol. 2020;56(02): 298–312. Doi: 10.1002/uog.22134 https://doi.org/10.1002/uog.22134...	SMFM³3 Martins JG, Biggio JR, Abuhamad ASociety for Maternal-Fetal Medicine (SMFM). Electronic address: pubs@smfm.org. Society for Maternal-Fetal Medicine Series #52: diagnosis and management of fetal growth restriction: (Replaces Clinical Guideline Number 3, April 2012). Am J Obstet Gynecol. 2020;223(04):B2-–B17. Doi: 10.1016/j.ajog.2020.05.010 https://doi.org/10.1016/j.ajog.2020.05.0...	FCOG⁵5 Vayssière C, Sentilhes L, Ego A, et al. Fetal growth restriction and intra-uterine growth restriction: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians. Eur J Obstet Gynecol Reprod Biol. 2015;193:10–18. Doi: 10.1016/j.ejogrb.2015.06.021 https://doi.org/10.1016/j.ejogrb.2015.06...	ACOG⁶6 Fetal Growth Restriction. Fetal Growth Restriction: ACOG Practice Bulletin, Number 227. Obstet Gynecol. 2021;137(02):e16–e28. Doi: 10.1097/AOG.0000000000004251 https://doi.org/10.1097/AOG.000000000000...
If no changes in Doppler	Doppler every 1-2 weeks	–	Doppler weekly	Doppler every 2-3 weeks	–
If early doppler changes (IP UA >p95 or IP MCA <p5)	Doppler 1-2 times a week and BP twice a week	–	Doppler weekly	Doppler weekly	–
If AEDF-UA	Doppler 3 times a week and BP daily	Doppler 2-3 times a week	Doppler 2-3 times a week and CTG daily	Doppler more than once a week and CTG daily	–
If REDF-UA	Doppler daily and BP twice a day	Doppler 2-3 times a week	CTG daily	Doppler more than once a week and CTG daily	–
If ductus venosus alteration (PI> p95, absent or reversed A wave)	Doppler daily and BP twice a day	–	–	–	–

	FIGO¹1 Melamed N, Baschat A, Yinon Y, 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. Int J Gynaecol Obstet. 2021;152(01):3–57. Doi: 10.1002/ijgo.13522 https://doi.org/10.1002/ijgo.13522...	ISUOG²2 Lees CC, Stampalija T, Baschat A, et al. ISUOG Practice Guidelines: diagnosis and management of small-for-gestational-age fetus and fetal growth restriction. Ultrasound Obstet Gynecol. 2020;56(02): 298–312. Doi: 10.1002/uog.22134 https://doi.org/10.1002/uog.22134...	SMFM³3 Martins JG, Biggio JR, Abuhamad ASociety for Maternal-Fetal Medicine (SMFM). Electronic address: pubs@smfm.org. Society for Maternal-Fetal Medicine Series #52: diagnosis and management of fetal growth restriction: (Replaces Clinical Guideline Number 3, April 2012). Am J Obstet Gynecol. 2020;223(04):B2-–B17. Doi: 10.1016/j.ajog.2020.05.010 https://doi.org/10.1016/j.ajog.2020.05.0...	FCOG⁵5 Vayssière C, Sentilhes L, Ego A, et al. Fetal growth restriction and intra-uterine growth restriction: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians. Eur J Obstet Gynecol Reprod Biol. 2015;193:10–18. Doi: 10.1016/j.ejogrb.2015.06.021 https://doi.org/10.1016/j.ejogrb.2015.06...	ACOG⁶6 Fetal Growth Restriction. Fetal Growth Restriction: ACOG Practice Bulletin, Number 227. Obstet Gynecol. 2021;137(02):e16–e28. Doi: 10.1097/AOG.0000000000004251 https://doi.org/10.1097/AOG.000000000000...
EFW p3-p10, no changes on Doppler (SGA)	37 to 39 weeks	38 to 39 weeks	38 to 39 weeks	–	38 + 0 to 39 + 6 weeks
EFW <p3 (isolated FGR), no changes on Doppler	36 to 38 weeks	36 to 37 weeks	37 weeks	–	37 weeks
Early Doppler changes (PI UA >p95, PI MCA <p5, CPR <p5, mean PI UtA >p95)	34 to 37 weeks (including changes such as oligohydramnios and suboptimal growth)	36 + 0 to 37 + 6 weeks	37 weeks	–	–
AEDF-UA	32 weeks	34 weeks	33 to 34 weeks	–	–
REDF-UA	30 weeks	32 + 0 to 33 + 6 weeks	30 to 32 weeks	–	–
Changes in the ductus venosus (PI >p95, absent or reversed A wave)	26 weeks	26 weeks	26 weeks	–	–

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[1] Address for correspondence Caio Ribeiro Vieira Leal, Avenida Alfredo Balena, 110, 301130-100, Belo Horizonte, MG, Brazil. (e-mail: lealcaiorv@gmail.com).

1-STV Criteria
	a) STV <2.6ms between 26 + 0 and 28 + 6
	b) STV <3.0ms between 29 + 0 and 31 + 6
	c) Delivery regardless of STV if there are spontaneous, repeated and persistent decelerations in CTG
2- UA Doppler Criteria
	a) AEDF-UA above 34 weeks
	b) REDF-UA over 32 weeks
	c) Following local protocols, delivery could be performed if AEDF-UA above 32 weeks or REDF-UA above 30 weeks