The Placental Basis of Fetal Growth Restriction

Obstet Gynecol Clin North Am. 2020 Mar;47(1):81-98. doi: 10.1016/j.ogc.2019.10.008. Epub 2019 Dec 18.


Placental dysfunction is a major contributing factor to fetal growth restriction. Placenta-mediated fetal growth restriction occurs through chronic fetal hypoxia owing to poor placental perfusion through a variety of mechanisms. Maternal vascular malperfusion is the most common placental disease contributing to fetal growth restriction; however, the role of rare placental diseases should not be overlooked. Although the features of maternal vascular malperfusion are identifiable on placental pathology, antepartum diagnostic methods are evolving. Placental imaging and uterine artery Doppler, used in conjunction with angiogenic growth factors (specifically placenta growth factor and soluble fms-like tyrosine kinase-1), play an increasingly important role.

Keywords: Fetal growth restriction (FGR); Fetal vascular malperfusion (FVM); Intrauterine growth restriction (IUGR); Maternal vascular malperfusion (MVM); Placental dysfunction; Placental growth factor (PlGF); Placental insufficiency; Placental pathology.

Publication types

  • Review

MeSH terms

  • Female
  • Fetal Growth Retardation / diagnosis
  • Fetal Growth Retardation / etiology*
  • Humans
  • Infant, Newborn
  • Placenta / diagnostic imaging*
  • Pregnancy
  • Ultrasonography, Doppler / methods
  • Ultrasonography, Prenatal / methods*