Current concepts of fetal growth restriction: part II. Diagnosis and management

To update diagnostic concepts and management strategies of fetal growth restriction (FGR).

An English literature search was conducted for pertinent articles related to FGR from 1976 to 1997 including original research articles, review articles, and book chapters.

In part II, clinical studies involving both diagnostic and therapeutic approaches to the management of FGR were included. Throughout the study period, the evolution of concepts is demonstrated.

Diagnostic methods including two- and three-dimensional ultrasound for diagnosis of fetal structural abnormalities, organ volumetry, and estimating fetal weight are presented. Clinical tools to assess fetal well-being such as nonstress tests, contraction stress tests, biophysical profile scores, and Doppler blood flow velocimetry of fetal circulation and funicentesis are discussed. Correlations between these indirect fetal evaluations and fetal blood biochemical parameters obtained by funicentesis are also reviewed. Finally, various therapeutic approaches, especially timing of delivery of growth-restricted fetuses, are formulated.

We suggest that both diagnostic and therapeutic approaches to FGR should be modified. With the current development of technology, newly available three-dimensional ultrasound might offer more precise diagnostic data than conventional two-dimensional ultrasonography in the near future. From current concepts of pathophysiology of FGR, morphometric measurement abnormality alone should not be a basis for intervention. Combined use of morphometric measurements and functional evaluation tests and good clinical judgment using flexibility and individualization are the key elements in successful management of FGR.