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Fetal growth retardation – diagnosis and treatment

HEALTH OF WOMAN. 2017.6(122):144–151

Institute of Obstetricians and Gynecologists of the Irish Royal Medical College and the Directorate of Clinical Strategy and Programs of the Executive Health Service Version: 1.1 Publication date: March 2014 Handbook № 28. Date of revision: March 2017. Abridged version. Adapted – S.A. Shurpyak


Reports and Recommendations       

1. American College of Obstetricians and Gynecologists. (2013). «Fetal Growth Restriction». ACOG Practice Bulletin 134.

2. Health Research and Information Division, the Economic and Social Research Institute (ESRI), Ireland. 2010. Perinatal Statistics Report. National Perinatal Reporting System (NPRS).

3. National Perinatal Epidemiology Centre (NPEC). 2011. Perinatal Mortality in Ireland Annual Report.

4. Royal College of Obstetricians and Gynaecologists. 2013. The Investigation and Management of the Small-for-Gestational-Age Fetus. RCOG Green-top Guideline 31.

5. Berkley E, Chauhan S, Abuhamad A. 2012. Society for Maternal-Fetal Medicine Publications Committee. Doppler assessment of the fetus with intrauterine growth restriction. American Journal of Obstetrics & Gynecology 206(4): 300–308. https://doi.org/10.1016/j.ajog.2012.01.022; PMid:22464066

6. Society of Obstetricians and Gynaecologists of Canada. 2013. Clinical Practice Guideline 295. Intrauterine Growth Restriction: Screening, Diagnosis, and Management. Journal of Obstetrics and Gynecology Canada 35(8):741–748. https://doi.org/10.1016/S1701-2163(15)30865-3


1. Alfirevic Z, Stampalija T, Gyte GM. 2010. Fetal and umbilical Doppler ultrasound in high-risk pregnancies. Cochrane Database of Systematic Reviews. CD007529. https://doi.org/10.1002/14651858.CD007529.pub2

2. Barker DJ. 1990. The fetal and infant origins of adult disease. The BMJ. 301(6761):1111. https://doi.org/10.1136/bmj.301.6761.1111; PMid:2252919 PMCid:PMC1664286

3. Barker DJ, Gluckman PD, Godfrey KM, Harding JE, Owens JA, Robinson JS. 1993. Fetal nutrition and cardiovascular disease in adult life. Lancet. 341(8850):938–941. https://doi.org/10.1016/0140-6736(93)91224-A

4. Barker ED, McAuliffe FM, Alderdice F, Unterscheider J, Daly S, Geary MP et al. 2013. The Role of Growth Trajectories to Identify Fetal Growth Restriction. Obstetrics & Gynecology 122:248–54. https://doi.org/10.1097/AOG.0b013e31829ca9a7; PMid:23969791

5. Baschat AA, Cosmi E, Bilardo CM et al. 2007. Predictors of neonatal outcome in early-onset placental dysfunction. Obstetrics & Gynecology 109:253–261. https://doi.org/10.1097/01.AOG.0000253215.79121.75; PMid:17267821

6. Bilardo CM, Wolf H, Stigter RH, Ville Y, Baez E, Visser GH et al. 2004. Relationship between monitoring parameters and perinatal outcome in severe, early intrauterine growth restriction. Ultrasound in Obstetrics & Gynecology 23:119–25. https://doi.org/10.1002/uog.965; PMid:14770389

7. Boers KE, Bijlenga D, Mol BW et al. 2007. Disproportionate Intrauterine Growth Intervention Trial At Term: DIGITAT. BMC Pregnancy and Childbirth 7:12. https://doi.org/10.1186/1471-2393-7-12; PMid:17623077 PMCid:PMC1933438

8. Boers KE, van Wyk L, van der Post JA et al. 2012. Neonatal morbidity after induction vs expectant monitoring in intrauterine growth restriction at term: a subanalysis of the DIGITAT RCT. American Journal of Obstetrics & Gynecology 206(4):344 e341–347.

9. Bracero LA, Morgan S, Byrne DW. 1999. Comparison of visual and computerized interpretation of nonstress test results in a randomized controlled trial. American Journal of Obstetrics & Gynecology 181(5;1):1254–8.

10. Bricker L, Neilson JP, Dowswell T. 2008. Routine ultrasound in late pregnancy (after 24 weeks’ gestation). Cochrane Database of Systematic Reviews (4):CD001451. https://doi.org/10.1002/14651858.CD001451.pub3

11. Bujold E, Roberge S, Lacasse Y, Bureau M, Audibert F, Marcoux S, Forest JC, Giguere Y. 2010. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstetrics & Gynecology 116(2;1):402–14.

12. Chauhan SP, Beydoun H, Chang E et al. 2013. Prenatal Detection of Fetal Growth Restriction in Newborns Classified as Small for Gestational Age: Correlates and Risk of Neonatal Morbidity. American Journal of Perinatology.

13. Cnossen JS, Morris RK, ter Riet G et al. 2008. Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis. Canadian Medical Association Journal 178(6):701–11. https://doi.org/10.1503/cmaj.070430; PMid:18332385 PMCid:PMC2263112

14. Dawes GS, Moulden M, Redman CW. 1992. Short-term fetal heart rate variation, decelerations, and umbilical flow velocity waveforms before labor. Obstetrics & Gynecology 80:673–8. PMid:1407893

15. Dodd JM, McLeod A, Windrim RC, Kingdom J. 2013. Antithrombotic therapy for improving maternal or infant health outcomes in women considered at risk of placental dysfunction. Cochrane Database of Systematic Reviews. 7:CD006780. https://doi.org/10.1002/14651858.CD006780.pub3.

16. Evertson LR, Gauthier RJ, Schifrin BS, Paul RH. 1979. Antepartum fetal heart rate testing. Evolution of the nonstress test. American Journal of Obstetrics & Gynecology 133:29–33. https://doi.org/10.1016/0002-9378(79)90406-X

17. Ferrazzi E, Bozzo M, Rigano S, Bellotti M, Morabito A, Pardi G et al. 2002. Temporal sequence of abnormal Doppler changes in the peripheral and central circulatory systems of the severely growth-restricted fetus. Ultrasound in Obstetrics & Gynecology 19:140–6. https://doi.org/10.1046/j.0960-7692.2002.00627.x; PMid:11876805

18. Figueras F, Figueras J, Meler E et al. 2007. Customized birthweight standards accurately predict perinatal morbidity. Archives of Disease in Childhood – Fetal and Neonatal Edition. 92:F277-F280. https://doi.org/10.1136/adc.2006.108621; PMid:17251224 PMCid:PMC2675427

19. Gardosi J, Chang A, Kalyan B, Sahota D, Symonds EM. 1992. Customised antenatal growth charts. The Lancet. 339(8788):283–287. https://doi.org/10.1016/0140-6736(92)91342-6

20. Gardosi J & Francis A. 1999. Controlled trial of fundal height measurement plotted on customised antenatal growth charts. British Journal of Obstetrics and Gynaecology 106:309–317. https://doi.org/10.1111/j.1471-0528.1999.tb08267.x; PMid:10426236

21. Groom KM, Poppe KK, North RA et al. 2007. Small-for-gestational age infants classified by customized or population birthweight centiles: Impact of gestational age at delivery. American Journal of Obstetrics & Gynecology 197:239.e1-239.e5. https://doi.org/10.1016/j.ajog.2007.06.038; PMid:17826403

22. Grivell RM, Wong L, Bhatia V. 2012. Regimens of fetal surveillance for impaired fetal growth. Cochrane Database of Systematic Reviews. 6:CD007113. https://doi.org/10.1002/14651858.CD007113.pub3

23. Hadlock FP, Harrist RB, Sharman RS, Deter RL, Park SK. 1985. Estimation of fetal weight with the use of head, body, and femur measurements – a prospective study. American Journal of Obstetrics & Gynecology 151(3):333–337. https://doi.org/10.1016/0002-9378(85)90298-4

24. Hornbuckle J, Vail A, Abrams KR, Thornton JG. 2000. Bayesian interpretation of trials: the example of intrapartum electronic fetal heart rate monitoring. British Journal of Obstetrics and Gynaecology 107:3–10. https://doi.org/10.1111/j.1471-0528.2000.tb11571.x; PMid:10645854

25. Kingdom JC, Drewlo S. 2011. Is heparin a placental anticoagulant in high-risk pregnancies? Blood. 118(18):4780-8. https://doi.org/10.1182/blood-2011-07-319749; PMid:21868576

26. Lees C, Baumgartner H. 2005. The TRUFFLE study–a collaborative publicly funded project from concept to reality: how to negotiate an ethical, administrative and funding obstacle course in the European Union. Ultrasound in Obstetrics & Gynecology 25:105–7. https://doi.org/10.1002/uog.1836; PMid:15685670

27. Lees C et al. 2013. Perinatal morbidity and mortality in early-onset fetal growth restriction: cohort outcomes of the trial of randomized umbilical and fetal flow in Europe (TRUFFLE). Ultrasound in Obstetrics & Gynecology 42:400–408. https://doi.org/10.1002/uog.13190; PMid:24078432

28. Manning E, Corcoran P, Meaney S, Greene RA2011. Оn behalf of the Perinatal Mortality Group. Perinatal Mortality in Ireland Annual Report. National Perinatal Epidemiology Centre.

29. Manning FA, Platt LD, Sipos L. 1980. Antepartum fetal evaluation: development of a fetal biophysical profile. American Journal of Obstetrics & Gynecology 136(6):787–95. https://doi.org/10.1016/0002-9378(80)90457-3

30. Manning FA. 1995. Dynamic ultrasound-based fetal assessment: the fetal biophysical profile score. Clinical Obstetrics and Gynecology 38:26. https://doi.org/10.1097/00003081-199503000-00006; PMid:7796550

31. Manning FA, Baskett TF, Morrison I, Lange I. 1981. Fetal biophysical profile scoring: a prospective study in 1,184 high-risk patients. American Journal of Obstetrics & Gynecology. 140(3):289. https://doi.org/10.1016/0002-9378(81)90275-1

32. McCowan LM, Roberts CT, Dekker GA et al. 2010. Risk factors for small-for- gestational-age infants by customised birthweight centiles: data from an international prospective cohort study. British Journal of Obstetrics and Gynaecology 117(13):1599-1607. https://doi.org/10.1111/j.1471-0528.2010.02737.x; PMid:21078055

33. McCowan LM, Harding JE, Stewart AW. 2005. Customized birthweight centiles predict SGA pregnancies with perinatal morbidity. British Journal of Obstetrics and Gynaecology. 112:1026–1033. https://doi.org/10.1111/j.1471-0528.2005.00656.x; PMid:16045513

34. Mongelli M & Gardosi J. 2004. Estimation of fetal weight by symphysis–fundus height measurement. International Journal of Gynaecology & Obstetrics 85:50–51. https://doi.org/10.1016/j.ijgo.2003.08.002; PMid:15050470

35. Pattison N, McCowan L. 2000. Cardiotocography for antepartum fetal assessment. Cochrane Database of Systematic Reviews. CD001068. PMid:10796239

36. Pilliod RA, Cheng YW, Snowden JM, Doss AE, Caughey AB. 2012. The risk of intrauterine death in the small-for-gestational-age fetus. American Journal of Obstetrics & Gynecology 207:318.e1-6. https://doi.org/10.1016/j.ajog.2012.06.039; PMid:23021697 PMCid:PMC3724359

37. Redline RW. 2008. Placental pathology: a systematic approach with clinical correlations. Placenta 29(A):S86-91.

38. Roberge S, Giguere Y, Villa P, Nicolaides K, Vainio M, Forest JC, von Dadelszen P, Vaiman D, Tapp S. 2013. Early Administration of Low-Dose Aspirin for the Prevention of Severe and Mild Preeclampsia: A Systematic Review and Meta-Analysis. American Journal of Perinatology. https://doi.org/10.1055/s-0033-1343351; PMid:23271387

39. Rondo PH, Maia Filho NL & Valverde KK. 2003. Symphysis–fundal height and size at birth. International Journal of Gynaecology & Obstetrics 81:53–54. https://doi.org/10.1016/S0020-7292(02)00407-1

40. Strutchfiled P, Whitaker R, Russell I et al. 2005. Antenatal betamethasone and the incidence of neonatal respiratory distress after elective caesarean section: pragmatic randomised trial. The BMJ. 331:662–4. https://doi.org/10.1136/bmj.38547.416493.06; PMid:16115831 PMCid:PMC1226243

41. Strutchfiled PR, Whitaker R, Gliddon AE, Hobson L, Kotecha S, Doull IJM. 2013. Behavioural, educational and respiratory outcomes of antenatal betamethasone for term caesarean section (ASTECS trial). Archives of Disease in Childhood – Fetal and Neonatal Edition 98:F198-200.

42. Trudell AS, Cahill AG, Tuuli MG, Macones GA, Odibo AO. 2013. Risk of stillbirth after 37 weeks in pregnancies complicated by small-for-gestational-age fetuses. American Journal of Obstetrics & Gynecology 208:376e1-7.

43. Unterscheider J, Geary MP, Daly S, McAuliffe FM, Kennelly MM, Dornan J et al. 2013. The customised fetal growth potential: a standard for Ireland. European Journal of Obstetrics & Gynecology and Reproductive Biology 166(1):14–7. https://doi.org/10.1016/j.ejogrb.2012.09.007; PMid:23068999

44. Unterscheider J, Daly S, Geary MP, Kennelly MM, McAuliffe FM, O’Donoghue K, Hunter A, Morrison JJ, Burke G, Dicker P, Tully EC, Malone FD. 2013. Optimizing the Definition of Intrauterine Growth Restriction – Results of the Multicenter Prospective PORTO Study. American Journal of Obstetrics & Gynecology 208(4):290.e1-6. https://doi.org/10.1016/j.ajog.2013.02.007; PMid:23531326

45. Unterscheider J, Daly S, Geary MP, Kennelly MM, McAuliffe FM, O’Donoghue K, Hunter A, Morrison JJ, Burke G, Dicker P, Tully EC, Malone FD. 2013. Predictable Progressive Doppler Deterioration in IUGR – Does it really exist? American Journal of Obstetrics & Gynecology:pii: S0002-9378(13)00927-7. doi 10.1016/j.ajog.2013.08.039.

46. van Wyk L, Boers KE, van der Post JA et al. 2012. Effects on (neuro)developmental and behavioral outcome at 2 years of age of induced labor compared with expectant management in intrauterine growth-restricted infants: long-term outcomes of the DIGITAT trial. American Journal of Obstetrics & Gynecology 206(5):406 e401-407.

47. Voskamp BJ, Kazemier BM, Ravelli AC, Schaaf J, Mol BW, Pajkrt E. 2013. Recurrence of small-for-gestational-age pregnancy: analysis of first and subsequent singleton pregnancies in The Netherlands. American Journal of Obstetrics & Gynecology 208(5):374 e1-6.

48. Wright J, Morse K, Kady S et al. 2006. Audit of fundal height measurements plotted on customised growth charts. MIDIRS Midwifery Digest 16(3):341–345.