Timing of Delivery for Small for Gestational Age (SGA) Babies

Delivery Timing Based on Doppler Status

The American College of Obstetricians and Gynecologists recommends delivery at 38-39 weeks gestation for SGA babies with normal umbilical artery Doppler and estimated fetal weight between 3rd-10th percentile 1
For isolated SGA with normal Doppler and normal amniotic fluid, the American Journal of Obstetrics and Gynecology suggests delaying delivery until 37 weeks but no later than 40 weeks 2
The American College of Obstetricians and Gynecologists recommends delivery at 37 weeks gestation for SGA babies with decreased end-diastolic flow in the umbilical artery Doppler 1
For SGA babies with absent end-diastolic velocity, the American College of Obstetricians and Gynecologists recommends delivery at 33-34 weeks gestation 1, 3
The American Journal of Obstetrics and Gynecology states that national guidelines show consensus with recommended delivery ranging from 32-34 weeks for SGA babies with absent end-diastolic velocity 4, 5
The American College of Obstetricians and Gynecologists recommends delivery at 30-32 weeks gestation for SGA babies with reversed end-diastolic velocity in the umbilical artery Doppler 1, 6

The American College of Obstetricians and Gynecologists recommends serial umbilical artery Doppler every 2 weeks for SGA babies with normal Doppler 1
For SGA babies with decreased end-diastolic velocity or severe SGA, the American College of Obstetricians and Gynecologists suggests weekly umbilical artery Doppler 1
The American College of Obstetricians and Gynecologists recommends Doppler assessment 2-3 times per week for SGA babies with absent end-diastolic velocity 1
For SGA babies with reversed end-diastolic velocity, the American College of Obstetricians and Gynecologists recommends hospitalization with cardiotocography 1-2 times per day 1

The American College of Obstetricians and Gynecologists recommends administering antenatal corticosteroids if delivery is anticipated before 33 6/7 weeks 1, 6
The American Journal of Obstetrics and Gynecology states that universal agreement exists on corticosteroid use before 34 weeks across all national guidelines 4, 5
The American College of Obstetricians and Gynecologists recommends administering magnesium sulfate for fetal neuroprotection for pregnancies less than 32 weeks gestation 1, 6
The American Journal of Obstetrics and Gynecology suggests that general consensus exists across guidelines for use of magnesium sulfate in early-onset FGR (less than 32 weeks) 4, 5

The American Journal of Obstetrics and Gynecology states that FGR alone is not an indication for cesarean delivery when umbilical artery end-diastolic flow is present 2
The American Journal of Obstetrics and Gynecology recommends continuous fetal monitoring in labor for all SGA pregnancies 2
The American College of Obstetricians and Gynecologists recommends cesarean delivery for very preterm FGR or severe umbilical artery Doppler abnormalities (AEDV/REDV) 1, 2