Approach to identification of fetal growth restriction in singleton pregnancies in the third trimester

FGR: fetal growth restriction; EFW: estimated fetal weight; AC: abdominal circumference; NST: nonstress test; AFV: amniotic fluid volume; BPP: biophysical profile.

* To assess FGR risk, refer to UpToDate content on causes and risk factors for FGR. Patients with multiple gestations, extremes of amniotic fluid volume, or large or multiple leiomyomas and some patients with obesity are not appropriate candidates for measurement of the symphysis to top of the fundus distance alone because it does not correlate well with fetal size in these settings.

¶ The most common criterion for discordancy is a fundal height in centimeters that is ≥4 centimeters less than the gestational age in weeks.

Δ EFW or AC <10th percentile or oligohydramnios.

◊ The frequency of monitoring and use of additional types of monitoring (eg, ductus venosus) need to be individualized. The timing of delivery is based on a combination of factors, including gestational age, umbilical artery Doppler findings, BPP score, nonstress test result, ductus venosus Doppler, and the level of risk (number and type of risk factors for FGR that are present). The goal is to maximize fetal maturity and growth while minimizing the risks of fetal or neonatal mortality and short-term and long-term morbidity. Refer to UpToDate content on evaluation and management of FGR.