Population: Pregnant women with fetal growth restriction.

Organization

ACOG 2021

Recommendations

Evaluation

–Define as an estimated fetal weight <10th percentile for gestational age, though fetuses <third percentile are at highest risk of adverse outcomes.

–Monitor with serial umbilical artery assessments. Umbilical artery Doppler velocimetry used in conjunction with standard fetal surveillance, such as nonstress tests, biophysical profiles, or both, is associated with improved outcomes.

Management

–Optimal timing of delivery is unclear. Consider delivery at 38-0/7 to 39-0/7 wk for 3rd–10th percentile with normal umbilical artery Doppler, at 37 0/7 if <third percentile, and promptly at diagnosis regardless of EGA if umbilical artery flow is absent or reverse. When possible, reach these decisions in consultation with a maternal-fetal specialist.

–Offer antenatal corticosteroids if delivery is anticipated before 33-6/7 wk of gestation and between 34-0/7 and 36-6/7 wk of gestation if risk of preterm delivery within 7 d and no previous course of corticosteroids.

–Consider magnesium sulfate for delivery before 32 wk of gestation for fetal and neonatal neuroprotection.

–Do not recommend nutritional and dietary supplemental strategies for the prevention of fetal growth restriction as they are not effective.

Source

–ACOG. Practice Bulletin No 227. Fetal Growth Restriction. 2021.