Fetal Growth Restriction Management

Diagnosis and Risks

The American College of Obstetricians and Gynecologists recommends that fetal growth restriction (FGR) be diagnosed when the estimated fetal weight (EFW) or abdominal circumference (AC) is less than the 10th percentile for gestational age, with severe FGR defined as EFW less than the 3rd percentile 1, 2, 3, 5
FGR is associated with a 2-fold increased risk of stillbirth, with rates increasing to 2.5% for fetuses below the 5th percentile, as well as elevated risks of perinatal asphyxia, severe acidosis, low Apgar scores, and NICU admissions 1, 2
The American College of Obstetricians and Gynecologists notes that preterm FGR compounds risk, with 2- to 5-fold increased perinatal death rates compared to term FGR 1, 2

The American College of Obstetricians and Gynecologists recommends weekly umbilical artery Doppler evaluation for severe FGR (EFW <3rd percentile) with normal Doppler, and weekly cardiotocography 5, 3
For FGR with decreased diastolic flow (but not absent/reversed), the American College of Obstetricians and Gynecologists suggests weekly cardiotocography and serial umbilical artery Doppler monitoring 1, 6
The American College of Radiology recommends biophysical profile (BPP) for immediate assessment of fetal well-being, with a reassuring BPP associated with very low risk of fetal loss over the succeeding week 7

The American College of Obstetricians and Gynecologists recommends administering corticosteroids if delivery is anticipated before 33 6/7 weeks or between 34 0/7 and 36 6/7 weeks in women at risk of preterm delivery within 7 days who haven't received a prior course 1, 2
The American College of Obstetricians and Gynecologists suggests giving magnesium sulfate intrapartum for fetal neuroprotection when delivery is anticipated <32 weeks of gestation 1, 2
The American College of Cardiology notes that low-dose aspirin may prevent FGR in certain high-risk patients when started early in pregnancy 8

The American College of Obstetricians and Gynecologists recommends delivery at 37 weeks of gestation for FGR with normal Doppler, 37 weeks for severe FGR (EFW <3rd percentile) with normal Doppler, and 33-34 weeks for FGR with absent end-diastolic velocity 1, 2, 3
For FGR with reversed end-diastolic velocity, the American College of Obstetricians and Gynecologists suggests delivery at 30-32 weeks of gestation 1, 2, 3

The American College of Obstetricians and Gynecologists recommends considering chromosomal microarray analysis (CMA) for early-onset FGR (<32 weeks), especially when accompanied by fetal malformations or polyhydramnios 5
A detailed fetal structural survey is essential, as approximately 10-20% of fetuses with FGR have congenital anomalies or chromosomal disorders 1, 4