Maternal-Fetal Medicine: Diagnosis & Management of Fetal Growth Restriction
This information provides guidelines for monitoring fetal growth based on estimated fetal weight, abdominal circumference, uterine artery Doppler, non-stress test, and biophysical profile. It outlines strategies for surveillance, including frequency and types of tests based on gestational age and growth percentiles. Special considerations for cases where growth restriction is detected are also discussed, referencing Society for Maternal-Fetal Medicine Consult Series #52.
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EFW </=10th, AC >10th EFW UAD NST BPP f/u US Delivery timing 3rd-10th normal Weekly weekly UAD 2 weeks Growth 4 weeks 38-39 wks 3rd-10th elevated Twice weekly weekly UAD/BPP weekly Growth 3 weeks 37 wks <3rd normal Twice weekly weekly UAD 2 weeks Growth 4 weeks 37 wks <3rd elevated Twice weekly weekly UAD/BPP weekly Growth 2-3 weeks 37 wks
AC <10th, UAD normal EFW NST BPP f/u US Delivery timing >20th no no Growth 3 weeks 39 wks 11-20th Weekly at 32 week or more no UAD 2 weeks Growth 4 weeks 39 wks 3rd-10th weekly weekly UAD 2 weeks Growth 4 weeks 38-39 wks <3rd Twice weekly weekly UAD/BPP weekly Growth 2-3 weeks 37 wks
AC <10th, UAD >95th%ile for EGA EFW NST BPP f/u US Delivery timing >20th weekly Prn NR NST Weekly UAD Growth 3 wks 37 wks 11-20th weekly Prn NR NST Weekly UAD Growth 3 wks 37 wks 3rd-10th Twice weekly weekly Weekly UAD Growth 3 wks 37 wks <3rd Twice weekly weekly UAD weekly Growth 2 weeks 37 wks ***May increase surveillance for coincident comorbidities or risk factors
AC <10th, Special considerations EFW UAD NST BPP f/u US Delivery timing ANY ABSENT 2-3x/week weekly 2-3x/week UAD Growth 2 wks 33-34 wks Likely C/S ANY REVERSE 1-2x/day In hospital daily Growth 2 wks 30-32 wks Likely C/S ANY ANY 1-2x/day In hospital q 24-72 hours MVP <2 cm UAD weekly Growth 2 weeks At dx if 34wks or more
Reference Society for Maternal-Fetal Medicine (SMFM) Consult Series #52: Diagnosis and Management of Fetal Growth Restriction: Juliana Gevaerd Martins, MD; Joseph R. Biggio MD, MS; and Alfred Abuhamad, MD published May 2020