ACOG / SMFM released a guidance update on fetal growth restriction (FGR). While there is currently no clear consensus on the definition, evaluation, and management, FGR is associated with adverse perinatal outcomes. Therefore, timely diagnosis and management is key to optimizing long term benefit. Ultrasound and fundal height measurement are important physical exam diagnostic maneuvers. Early delivery and expectant management have similar outcomes thus creating deliberate birth plans should be discussed.
Maternal Disease
Note: Nutrition, oxygenation, and cardiovascular adaptation to pregnancy (placental perfusion) are underlying maternal factor mechanisms that impact fetal growth
Fetal Factors
Placental Anomalies
Note: Placental implantation abnormalities (e.g. placental accreta spectrum, previa) not associated with FGR
Note: No current evidenced based screening methods or preventative measures such as bed rest have demonstrated improved perinatal outcomes
Note: If delivery planned <34 weeks, deliver at center with a NICU and consult MFM
Note: “Consider” magnesium sulfate (neuroprotection) if delivery <32w0d
…it may be reasonable to perform serial ultrasonography for growth assessment, although the optimal surveillance regimen has not been determined.
Maternal history of a prior SGA newborn with normal fetal growth in the current pregnancy is not an indication for antenatal fetal heart rate testing, biophysical profile testing, or umbilical artery Doppler velocimetry
Note: There is insufficient evidence to routinely administer aspirin to prevent SGA in this population
ACOG Practice Bulletin 227: Fetal Growth Restriction
Effect of Maternal Heart Disease on Fetal Growth
Maternal Fetal Medicine Specialist Locator-SMFM
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