Doppler ultrasound of umbilical and middle cerebral artery in third trimester small-for-gestational age fetuses to decide on timing of delivery for suspected fetal growth restriction: A cohort with nested RCT (DRIGITAT).

Objective: To assess the association of the umbilicocerebral ratio (UCR) with adverse perinatal outcome in late preterm small-for-gestational age (SGA) fetuses and to investigate the effect on perinatal outcomes of immediate delivery.

Design: Multicentre cohort study with nested randomised controlled trial (RCT).

Setting: Nineteen secondary and tertiary care centres.

Practice variation in diagnosis, monitoring and management of fetal growth restriction in the Netherlands.

Objectives: Fetal growth restriction (FGR) is a condition characterized by its complexity in diagnosis and management. There is a need for early accurate diagnosis, evidence-based monitoring and management of FGR to improve neonatal outcomes. This study evaluated differences and similarities in protocols of Dutch hospitals in the approach of (suspected) FGR in the context of the national guideline.

Study protocol for a randomized trial on timely delivery versus expectant management in late preterm small for gestational age pregnancies with an abnormal umbilicocerebral ratio (UCR): the DRIGITAT study.

Background: The clinical inability to correctly identify late fetal growth restriction (FGR) within a group of fetuses who are identified as small for gestational age (SGA) is an everyday problem for all obstetrician-gynecologists. This leads to substantial overtreatment of healthy small fetuses but also inadequate detection of the growth-restricted fetuses that may benefit from timely delivery. Redistribution of the fetal circulation, signaled by an abnormal ratio of the Doppler velocity flow profiles of the umbilical artery and the middle cerebral artery, more specifically an increased umbilicocerebral ratio (UCR) (or its inverse: a decreased cerebroplacental ratio (CPR)), is an adaptation to chronic hypoxemia and nutritional scarcity with long-term consequences in survivors.

The Possible Role of Placental Morphometry in the Detection of Fetal Growth Restriction.

Fetal growth restriction (FGR) is often the result of placental insufficiency and is characterized by insufficient transplacental transport of nutrients and oxygen. The main underlying entities of placental insufficiency, the pathophysiologic mechanism, can broadly be divided into impairments in blood flow and exchange capacity over the syncytiovascular membranes of the fetal placenta villi. Fetal growth restriction is not synonymous with small for gestational age and techniques to distinguish between both are needed.

On the relevance of microecosystems for risk assessment: some considerations for environmental toxicology.

Microecosystems (any multispecies system with at least two trophic levels and its abiotic surroundings, (partly) enclosed by artificial boundaries for the purpose of research) differ from natural ecosystems by reason of enclosure and scale. Their application to environmental toxicology has been of interest where fate and behavior of contaminants markedly modify the exposure of biota to them and hence the environmental hazard. Evaluation of literature data, both from a scientific and a regulatory point of view, indicates that a standardized microecosystem design is unlikely to contribute to environmental hazard rating if it were to replace currently used test schedules.