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.
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Number 204 (Replaces Practice Bulletin No. 134, May 2013)
Committee on Practice Bulletins—Obstetrics and the Society for Maternal-Fetal Medicine. This Practice Bulletin was developed by the American College of Obstetricians and Gynecologists Committee on Practice Bulletins—Obstetrics and the Society for Maternal-Fetal Medicine Publications Committee with the assistance of Henry Galan, MD, and William Grobman, MD.
INTERIM UPDATE: This Practice Bulletin is updated as highlighted to reflect a limited, focused change to align with Committee Opinion No. 764, Medically Indicated Late-Preterm and Early-Term Deliveries, regarding delivery for fetal growth restriction, and Committee Opinion No. 713, Antenatal Corticosteroid Therapy for Fetal Maturation. In addition, there are updated data on delivery comparing changes in the ductus venosus Doppler versus fetal heart rate tracing changes.
Published online on January 24, 2019.
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Fetal growth restriction. ACOG Practice Bulletin No. 204. American College of Obstetricians and Gynecologists. Obstet Gynecol 2019;133:e97–109.