Prematurity and fetal growth restriction

Assessment of the growth status of the fetus and neonate is an essential component of perinatal care. It requires a distinction to be made between physiological and pathological factors, and the prediction of the optimal growth that a baby can achieve in a normal, uncomplicated pregnancy. Such an individually customised standard can now be easily calculated by computer: it needs to be accurately dated, individually adjusted for physiological characteristics, exclude pathological factors such as smoking, and be based on a fetal weight trajectory derived from normal term pregnancies. Application of a customised standard to calculate the growth status of preterm babies gives us fresh insights into the causes of prematurity. Fetal growth restriction is seen as a strongly associated factor, which is often present before the onset of spontaneous preterm tabour. This raises the question whether, in many instances, the initiation of parturition should be seen as a fetal adaptive response aimed at escaping an unfavourable intrauterine environment. These concepts have implications for the understanding of the pathophysiology of preterm tabour, as well as its clinical management. (C) 2004 Elsevier Ireland Ltd. All rights reserved.