Abstract
Fetal growth restriction (FGR) is defined as the failure of the fetus to meet its growth potential due to a pathological factor, most commonly placental dysfunction. Worldwide, FGR is a leading cause of stillbirth, neonatal mortality, and short- and long-term morbidity. Ongoing advances in clinical care, especially in definitions, diagnosis, and management of FGR, require efforts to effectively translate these changes to the wide range of obstetric care providers. This article highlights agreements based on current research in the diagnosis and management of FGR, and the areas that need more research to provide further clarification of recommendations. The purpose of this article is to provide a comprehensive summary of available evidence along with practical recommendations concerning the care of pregnancies at risk of or complicated by FGR, with the overall goal to decrease the risk of stillbirth and neonatal mortality and morbidity associated with this condition. To achieve these goals, FIGO (the International Federation of Gynecology and Obstetrics) brought together international experts to review and summarize current knowledge of FGR. This summary is directed at multiple stakeholders, including healthcare providers, healthcare delivery organizations and providers, FIGO member societies, and professional organizations. Recognizing the variation in the resources and expertise available for the management of FGR in different countries or regions, this article attempts to take into consideration the unique aspects of antenatal care in low-resource settings (labelled “LRS” in the recommendations). This was achieved by collaboration with authors and FIGO member societies from low-resource settings such as India, Sub-Saharan Africa, the Middle East, and Latin America.
Highlights
Introductionfetal growth restriction (FGR) is a common pregnancy complication that worldwide is a leading cause of stillbirth, neonatal mortality, and short- and long-term neonatal morbidity.[8,9,10,11,12,13,14,15] The definition, diagnosis, and optimal management of FGR have generated controversy as clinicians strive for more harmonized care.The purpose of this article is to provide a summary of the available evidence and provide recommendations regarding the early prediction and prevention, diagnosis, investigation, monitoring, and timing of delivery of pregnancies complicated by FGR, with the overall goal to decrease the risk of stillbirth and neonatal mortality and morbidity associated with this pregnancy complication
The purpose of this article is to provide a summary of the available evidence and provide recommendations regarding the early prediction and prevention, diagnosis, investigation, monitoring, and timing of delivery of pregnancies complicated by fetal growth restriction (FGR), with the overall goal to decrease the risk of stillbirth and neonatal mortality and morbidity associated with this pregnancy complication
We suggest that the decision regarding use of Biophysical profile (BPP)/nonstress test (NST) should be based on local practices, the risk profile of the local population, and the available resources in each particular setting. dTiming should be individualized based on local neonatal outcomes
Summary
FGR is a common pregnancy complication that worldwide is a leading cause of stillbirth, neonatal mortality, and short- and long-term neonatal morbidity.[8,9,10,11,12,13,14,15] The definition, diagnosis, and optimal management of FGR have generated controversy as clinicians strive for more harmonized care.The purpose of this article is to provide a summary of the available evidence and provide recommendations regarding the early prediction and prevention, diagnosis, investigation, monitoring, and timing of delivery of pregnancies complicated by FGR, with the overall goal to decrease the risk of stillbirth and neonatal mortality and morbidity associated with this pregnancy complication. FGR is a common pregnancy complication that worldwide is a leading cause of stillbirth, neonatal mortality, and short- and long-term neonatal morbidity.[8,9,10,11,12,13,14,15] The definition, diagnosis, and optimal management of FGR have generated controversy as clinicians strive for more harmonized care. FGR is defined as the failure of the fetus to meet its growth potential due to a pathological factor, most commonly placental dysfunction. This is reflected by a drop in fetal size percentiles over the course of gestation. In clinical practice, small for gestational age (SGA), defined as estimated fetal weight (EFW) or abdominal circumference below a certain threshold such as the 10th or 3rd percentile, is most commonly used to suspect FGR
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