Fetal Growth Restriction: A Pragmatic Approach

Area of Science:

• Perinatology
• Maternal-Fetal Medicine
• Obstetrics

Background:

• Accurate diagnosis of fetal growth restriction (FGR) is essential for optimal pregnancy management.
• Precise estimation of gestational age via history and early ultrasound is critical, as minor dating errors can significantly impact diagnosis.
• Risk stratification for adverse outcomes involves gestational age certainty, comorbidities, estimated fetal weight percentile, and umbilical artery waveform analysis.

Purpose of the Study:

• To outline the diagnostic criteria and optimal surveillance strategies for fetal growth restriction.
• To emphasize the importance of accurate gestational dating in diagnosing FGR.
• To clarify the role of various monitoring techniques in managing FGR.

Main Methods:

• Review of existing literature and clinical trial data, including the TRUFFLE trial.
• Analysis of diagnostic parameters such as gestational age, estimated fetal weight, and umbilical artery waveform.
• Evaluation of surveillance methods including electronic fetal heart rate monitoring, biophysical profile, and Doppler waveforms (ductus venosus, middle cerebral artery).

Main Results:

• Optimal management of FGR with abnormal umbilical artery waveform necessitates daily electronic fetal heart rate monitoring.
• Computerized interpretation is not required for electronic fetal heart rate monitoring in FGR surveillance.
• The utility of ductus venosus waveform, biophysical profile, and middle cerebral artery waveform in FGR management is less established and should be interpreted cautiously.

Conclusions:

• Precise gestational age estimation is fundamental for diagnosing fetal growth restriction.
• Daily electronic fetal heart rate monitoring is the primary surveillance method for FGR when umbilical artery Doppler is abnormal.
• While other monitoring modalities exist, their role is secondary to electronic fetal heart rate monitoring in specific FGR scenarios.