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Antenatal Surveillance of Fetal Growth Restriction

Thompson, Jennifer L. MD*; Kuller, Jeffrey A. MD; Rhee, Eleanor H. MD

Obstetrical & Gynecological Survey: September 2012 - Volume 67 - Issue 9 - p 554–565
doi: 10.1097/OGX.0b013e31826a5c6f
CME Program

Fetal growth restriction is a complex problem in modern obstetrics. It is a condition of suboptimal fetal growth based on a genetically predetermined potential and affects approximately 5% to 10% of pregnancies. It is traditionally defined as an estimated fetal weight less than the 10th percentile. Those pregnancies that are affected by growth restriction are associated with increased risk of perinatal morbidity and mortality. Because of this increased risk, these pregnancies are monitored more closely to try to identify those fetuses at the greatest risk of fetal demise and initiate delivery before this critical event. Although the ideal management strategy is still being determined, there are several modalities available to assist in assessment of the growth-restricted fetus. These include the nonstress test test, biophysical profile, and Doppler velocimetry, most commonly of the fetal umbilical artery, in addition to sonographic growth assessment. The use of multiple fetal assessment tools may help improve the prediction of adverse outcomes and initiate delivery before cardiovascular collapse.

Target Audience: Obstetricians & Gynecologists, Family Physicians

Learning Objectives: After completing this CME activity, physicians should be better able to evaluate the modalities available to assess fetal well-being in the growth-restricted fetus, identify the sequence of changes that occurs in fetal well-being assessment as the growth-restricted fetus deteriorates, and determine the changes signifying worsening fetal status that should prompt delivery.

*Fellow and Clinical Associate, †Professor, and ‡Assistant Professor, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Duke University Medical Center, Durham, NC

All authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commerical organizations pertaining to this educational activity.

Correspondence requests to: Jennifer L. Thompson, MD, DUMC Box 3967, Durham, NC 27710. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.