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    Fetal Growth Restriction

    Committee on Practice Bulletins - Obstetrics

    ACOG Practice Bulletin Number 134: Fetal Growth Restriction, May 2013 (Replaces Practice Bulletin Number 12, January 2000). Obstet Gynecol. 2013; 121: 1122-1133. Full text of ACOG Practice Bulletin is available to ACOG members at http://www.acog.org/Resources_And_Publications/Practice_Bulletins/committee_on_practice_bulletins_--_Obstetrics/Fetal_Growth_Restriction

    Fetal Growth Restriction

    Fetal growth restriction, also known as intrauterine growth restriction, is a common complication of pregnancy that has been associated with a variety of adverse perinatal outcomes. There is a lack of consensus regarding terminology, etiology, and diagnostic criteria for fetal growth restriction, with uncertainty surrounding the optimal management and timing of delivery for the growth-restricted fetus. An additional challenge is the difficulty in differentiating between the fetus that is constitutionally small and fulfilling its growth potential and the small fetus that is not fulfilling its growth potential because of an underlying pathologic condition. The purpose of this document is to review the topic of fetal growth restriction with a focus on terminology, etiology, diagnostic and surveillance tools, and guidance for management and timing of delivery.

    Used with permission. Copyright the American College of Obstetricians and Gynecologists.

    A rational approach to FGR

    Growth-restricted fetuses pose many clinical conundrums: How to identify them? How to distinguish the small and normal from the small and abnormal? How to manage them?  Once ultrasound weight projection tables became available more than 30 years ago, a major goal of prenatal care became how to prevent the morbidity and mortality of what was dubbed the growth-restricted fetus. The term “growth restriction” replaced “growth retardation” because of the negative prognostic connotations of the word “retardation.”

    Risk factors for fetal growth restriction are usually categorized as maternal, fetal, and placental. Only a few of these factors are readily modifiable, most notably substance abuse. Some risk factors, such as congenital infections, may be avoidable to a certain degree, whereas others fall into that more difficult category including exposures to medications that are important for maternal health. Frustratingly, controlling maternal diseases such as lupus and hypertension does not always improve birthweights.

    Periodically reviewing our state of knowledge about fetal growth restriction (FGR) is important. ACOG Practice Bulletin (PB) 134 reviews the etiologies of FGR and screening strategies for it, and addresses pertinent clinical questions.

    In PB 134, FGR and small-for-gestational-age (SGA) are distinguished by the time of identification. FGR is defined as the fetus with estimated weight below the 10th percentile, whereas SGA refers to newborns with weights below the 10th percentile for gestational age. This review will use those definitions, although SGA may be better used for fetuses thought to be constitutionally small and FGR for those with suspected pathology, usually as identified by abnormal Doppler findings.


    Joshua A. Copel, MD
    DR. COPEL is Professor, Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Director of ...


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