SMFM Recommendations: FGR Diagnosis and Management
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Discuss the definitions associated with fetal growth restriction (FGR) 2. Describe the fetal assessment options when a patient has been diagnosed with FGR
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from through , participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
SMFM has released guidance on fetal growth restriction (FGR), an evidence-based document that provides a standardized approach to diagnosis and management. The document emphasizes the importance of FGR as a significant pregnancy complication that
…occurs in up to 10% of pregnancies and is second to premature birth as a cause of infant morbidity and mortality. In addition to its significant perinatal impact, FGR also has an impact on long-term health outcomes
Absent end diastolic velocity (AEDV): 2 to 3 times/week
Reversed end diastolic velocity (REDV)
Administer antenatal corticosteroids
Perform NST 1 to 2 times/day | Low threshold for delivery depending on clinical scenario
Note: SMFM recommends against routine use of ductus venosus dopplers, middle cerebral artery dopplers, or uterine artery Doppler studies in early or late onset FGR | These studies have not been found to lead to improved accuracy over umbilical artery dopplers
FGR Prevention and Treatment
Due to lack of evidence, SMFM recommends against the use of the following for prevention of FGR
Prenatal aspirin (conflicting data including negative result in ASPRE trial)
SMFM recommends against the use for treatment of FGR
With oligohydramnios: 34w0d to 37w6d
Normal UA Doppler and EFW 3 to 10th percentile: 38 to 39 weeks
EFW <3rd percentile (severe FGR): 37 weeks
Decreased UA flow (S/D, RI, or PI > 95 percentile): 37 weeks
AEDV: 33 to 34 weeks
REDV: 30 to 32 weeks
Mode of Delivery
No strict recommendation for cesarean delivery based on FGR alone
Reserve for usual fetal and maternal indications
Mode of delivery for most cases of severe FGR with umbilical artery changes (AEDV or REDV): Cesarean delivery for fetal indication
Mode of delivery should be determined on a case-by-case basis, taking in to account clinical presentation and maternal preferences
FGR and Preterm
Administer corticosteroids and magnesium sulfate as per current guidelines
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
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