Optimal strategies for managing fetal growth restriction

Early dating of pregnancy by ultrasound is necessary to establish the adequate fetal growth. Customized or individualized estimation of fetal growth is probably a better option than population based curves to identify fetuses at a higher risk of perinatal complications. Biological maternal markers and placental evaluation might contribute in the identification of fetuses at risk of abnormal growth. There is no specific Doppler pattern of fetal deterioration; however, in early growth restriction it is mainly expressed in the umbilical artery, and in late growth restriction (>34 weeks) in the middle cerebral artery. Abnormal biophysical profile and/or non-stress test can be considered as acute signs of fetal decompensation. Magnetic resonance imaging can provide information of fetuses at risk of abnormal neurodevelopment. Neonatal body composition in low birthweight newborns can be used to identify children at risk of metabolic complications. Gestational age at delivery is the most important parameter associated with perinatal morbidity and mortality; however, waiting until the ductus venosus is severely abnormal might reduce the possibilities of survival of preterm fetuses with abnormal growth.