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Screening and diagnosis of fetal growth restriction: an expert review
Cecilia Villalaín1,2,3, Ignacio Herraiz1,2,3, Ranjit Akolekar4,5
1Fetal Medicine Unit, Obstetrics and Gynecology Department, Hospital Universitario 12 de Octubre, Complutense University, Madrid, Spain.
Insights
This study offers practical recommendations for diagnosing and screening fetal growth restriction (FGR) to improve perinatal outcomes globally. It provides updated criteria and context-sensitive strategies for diverse clinical settings.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Maternal-Fetal Medicine
Background:
- Fetal growth restriction (FGR) is linked to higher rates of perinatal morbidity and mortality.
- Early prenatal identification and intervention are crucial for improving FGR outcomes.
- Existing frameworks for FGR diagnosis and screening require updated, globally relevant recommendations.
Purpose of the Study:
- To provide evidence-based recommendations for the diagnosis and screening of FGR.
- To address diverse clinical settings, including high-income and low-to-middle-income countries.
- To support clinicians with practical guidance for FGR management.
Main Methods:
- A panel of experts was assigned topics related to FGR screening and diagnosis.
- Evidence was prioritized using the GRADE classification system.
- A practical approach was adopted, highlighting evidence for various diagnostic and screening options.
Main Results:
- Recommendations focus on a practical approach rather than prescriptive mandates for FGR definition and screening.
- The aim is to avoid unnecessary interventions and enhance perinatal outcomes.
- Updated diagnostic criteria and context-sensitive recommendations are provided.
Conclusions:
- This document expands upon existing frameworks for FGR management.
- It offers updated diagnostic criteria and tailored screening recommendations.
- The goal is to provide a globally relevant resource for clinicians managing FGR.
Background:
Fetal growth restriction (FGR) is associated to increased perinatal morbidity and mortality. Prenatal identification and subsequent intervention can improve outcomes. Our aim is to provide recommendations regarding the diagnosis and screening of FGR addresing diverse clinical settings-including both high-income and low-to-middle-income countries, as well as both referral and referring centers.
Methods:
An organizational committee assigned a panel of experts different topics regarding screening and diagnosis of FGR. Evidence was prioritized according to the GRADE classification system, with the highest levels of evidence given the greatest weight and organized in practical approach. Although most diagnostic and screening options are described, our aim is not to recommend all but to highlight the evidence for each one and give our recommendations for their use understanding that not all settings will have every option available.
Results:
We provide a practical approach over prescriptive mandates in the definition and screening strategies of FGR in order to avoid unnecessary or excessive interventions and improve perinatal outcomes. While not intended to establish a legal standard of care, we provide a globally relevant resource to support clinicians.
Conclusion:
This document broadens existing frameworks by incorporating updated diagnostic criteria, and context-sensitive recommendations for the screening of this pathology.
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