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Early severe fetal growth restriction: Evaluation and treatment

Early severe fetal growth restriction is an estimated fetal weight of less than 10th percentile for gestational age that may be secondary to maternal, fetal and placental causes.

Diagnosis/definition: Fetal growth restriction is an estimated fetal weight of less than the 10th percentile for gestational age.  

Risk factors/associations: Fetal growth restriction can be a result of several possible conditions, including maternal (e.g. vascular disease), fetal (e.g. aneuploidy, other genetic syndromes, infection), and placental (e.g. insufficiency). Maternal risk factors for fetal growth restriction are hypertension, systemic lupus, diabetes with vascular disease, complex cyanotic cardiac disease, smoking, illicit drug use, malnutrition, low socioeconomic status, family or obstetrical history of fetal growth restriction, and extremes of age.

Complications: Increased risk of stillbirth and neonatal morbidity

Management

Screening/Work-up: 

  • Detailed ultrasound focused on detection of fetal, umbilical, or placental anomalies.
  • Fetal biometry including measurements of long bones should be performed.  
  • Assessment of ultrasound markers of fetal aneuploidy or fetal infection.
  • Umbilical artery dopplers
  • o Measurement of amniotic fluid volume

Counseling for findings:

  • Offer amniocentesis
  • If ultrasound is concerning for fetal infection, maternal serologic screening or amniotic fluid PCR 

Antepartum testing: 

  • Fetal growth ultrasounds every 3-4 weeks
  • Surveillance with umbilical artery doppler ultrasound
  • Weekly or bi-weekly non-stress test or biophysical profile 

Delivery: Experts recommend delivery after steroids from 32-34 weeks in the setting of reversed umbilical artery end-diastolic velocity, and from 34 weeks for absent or reversed umbilical artery end-diastolic velocity.  However, these recommendations are not based on randomized trials.

Prevention: Effective interventions for prevention and/or management of recurrent fetal growth restriction may include:

  • Reproductive plan, including adequate spacing of pregnancies (e.g. 18-24 months between last delivery and next conception).
  • Optimization of maternal medical conditions.
  • Accurate dating by first trimester ultrasound.
  • Monitoring of fetal growth with serial sonograms.
  • Consider low dose aspirin (50-150mg) at or before 16 weeks gestation.   

Last Reaffirmed: Feb 1, 2013



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