Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:

Subscribers log in here

Fetal growth restriction: Diagnosis


A major focus of prenatal care is to determine whether a fetus is at risk for growth restriction and to identify the growth restricted fetus. Fetal growth is important because there is an inverse relationship between the fetal/neonatal weight percentile and adverse perinatal outcome, with the greatest risk at weights below the third percentile for gestational age [1,2]. In addition, fetal growth restriction appears to be an antecedent to some cases of hypertension, hyperlipidemia, coronary heart disease, and diabetes mellitus in the adult (Barker hypothesis). (See "Small for gestational age infant" and "Possible role of low birth weight in the pathogenesis of primary (essential) hypertension".)

Prenatal screening for fetal growth restriction (FGR) in general obstetrical populations involves identifying risk factors for impaired fetal growth and physically assessing fetal size. Clinical suspicion based upon risk factors or physical examination is followed by a detailed sonographic assessment of the fetus, placenta, and amniotic fluid. The most common sonography-based definition of FGR is a weight below the 10th percentile for gestational age, although other definitions employing a variety of criteria have been advocated. This definition is controversial because it does not make a distinction among fetuses who are constitutionally small, growth restricted and small, and growth restricted but not small (see 'Definition' below).

The goal of prenatal detection of fetuses that are small is to reduce the morbidity and mortality associated with this problem by employing some intervention. Although stillbirth rates are higher when FGR is not detected antenatally [3], there is only low quality evidence that antenatal identification of FGR improves outcome [4]. Unfortunately, significant problems remain in terms of defining the population of growth restricted fetuses at high risk of adverse outcome, accurately identifying these fetuses in utero, and determining interventions to improve outcome. These issues need to be addressed by large multicenter studies employing consistent definitions, randomly assigned interventions, and with long-term follow-up.

The diagnosis of FGR will be reviewed here. The etiology, management, and prognosis of this disorder are discussed separately. (See "Fetal growth restriction: Causes and risk factors" and "Fetal growth restriction: Evaluation and management" and "Small for gestational age infant".)


The most common definition of FGR refers to a weight below the 10th percentile for gestational age [5], although other definitions employing a variety of criteria have been advocated (eg, <5th percentile, <3rd percentile) [6,7]. This definition is problematic because it does not make a distinction among fetuses who are constitutionally small, small because a pathologic process has kept them from achieving their genetic growth potential, and not small but a pathologic process has kept them from achieving their genetic growth potential. It also requires an appropriate reference standard (table 1). Whether this standard should be based on birth weights across gestation, ultrasound-estimated fetal weights across gestation, or a customized standard, is also controversial [8]. The major criticism of the birth weight reference is that before term it is flawed because babies born preterm are often growth restricted. The ultrasound-based approach is limited by the inaccuracy and imprecision of ultrasound estimated fetal weight.


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jun 2014. | This topic last updated: Jun 20, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
  1. McIntire DD, Bloom SL, Casey BM, Leveno KJ. Birth weight in relation to morbidity and mortality among newborn infants. N Engl J Med 1999; 340:1234.
  2. Pilliod RA, Cheng YW, Snowden JM, et al. The risk of intrauterine fetal death in the small-for-gestational-age fetus. Am J Obstet Gynecol 2012; 207:318.e1.
  3. Gardosi J, Madurasinghe V, Williams M, et al. Maternal and fetal risk factors for stillbirth: population based study. BMJ 2013; 346:f108.
  4. Lindqvist PG, Molin J. Does antenatal identification of small-for-gestational age fetuses significantly improve their outcome? Ultrasound Obstet Gynecol 2005; 25:258.
  5. Battaglia FC, Lubchenco LO. A practical classification of newborn infants by weight and gestational age. J Pediatr 1967; 71:159.
  6. Seeds JW, Peng T. Impaired growth and risk of fetal death: is the tenth percentile the appropriate standard? Am J Obstet Gynecol 1998; 178:658.
  7. Zhang J, Mikolajczyk R, Grewal J, et al. Prenatal application of the individualized fetal growth reference. Am J Epidemiol 2011; 173:539.
  8. Zhang J, Merialdi M, Platt LD, Kramer MS. Defining normal and abnormal fetal growth: promises and challenges. Am J Obstet Gynecol 2010; 202:522.
  9. Manning, FA. Intrauterine growth retardation. In, Fetal Medicine. Principal and Practice. Norwalk, CT, Appleton & Lange 1995 p. 317.
  10. Minior VK, Shatzkin E, Divon MY. Nucleated red blood cell count in the differentiation of fetuses with pathologic growth restriction from healthy small-for-gestational-age fetuses. Am J Obstet Gynecol 2000; 182:1107.
  11. Resnik R. Intrauterine growth restriction. Obstet Gynecol 2002; 99:490.
  12. Uerpairojkit B, Chan L, Reece AE, et al. Cerebellar Doppler velocimetry in the appropriate- and small-for-gestational-age fetus. Obstet Gynecol 1996; 87:989.
  13. Bahado-Singh RO, Kovanci E, Jeffres A, et al. The Doppler cerebroplacental ratio and perinatal outcome in intrauterine growth restriction. Am J Obstet Gynecol 1999; 180:750.
  14. Harkness UF, Mari G. Diagnosis and management of intrauterine growth restriction. Clin Perinatol 2004; 31:743.
  15. Duff GB. A randomized controlled trial in a hospital population of ultrasound measurement screening for the small for dates baby. Aust N Z J Obstet Gynaecol 1993; 33:374.
  16. Belizán JM, Villar J, Nardin JC, et al. Diagnosis of intrauterine growth retardation by a simple clinical method: measurement of uterine height. Am J Obstet Gynecol 1978; 131:643.
  17. Robert Peter J, Ho JJ, Valliapan J, Sivasangari S. Symphysial fundal height (SFH) measurement in pregnancy for detecting abnormal fetal growth. Cochrane Database Syst Rev 2012; 7:CD008136.
  18. Rosenberg K, Grant JM, Tweedie I, et al. Measurement of fundal height as a screening test for fetal growth retardation. Br J Obstet Gynaecol 1982; 89:447.
  19. Walraven GE, Mkanje RJ, van Roosmalen J, et al. Single pre-delivery symphysis-fundal height measurement as a predictor of birthweight and multiple pregnancy. Br J Obstet Gynaecol 1995; 102:525.
  20. Rosenberg K, Grant JM, Hepburn M. Antenatal detection of growth retardation: actual practice in a large maternity hospital. Br J Obstet Gynaecol 1982; 89:12.
  21. Persson B, Stangenberg M, Lunell NO, et al. Prediction of size of infants at birth by measurement of symphysis fundus height. Br J Obstet Gynaecol 1986; 93:206.
  22. Lockwood CJ, Weiner S. Assessment of fetal growth. Clin Perinatol 1986; 13:3.
  23. Goetzinger KR, Tuuli MG, Odibo AO, et al. Screening for fetal growth disorders by clinical exam in the era of obesity. J Perinatol 2013; 33:352.
  24. Sparks TN, Cheng YW, McLaughlin B, et al. Fundal height: a useful screening tool for fetal growth? J Matern Fetal Neonatal Med 2011; 24:708.
  25. Jelks A, Cifuentes R, Ross MG. Clinician bias in fundal height measurement. Obstet Gynecol 2007; 110:892.
  26. Bailey SM, Sarmandal P, Grant JM. A comparison of three methods of assessing inter-observer variation applied to measurement of the symphysis-fundal height. Br J Obstet Gynaecol 1989; 96:1266.
  27. Roex A, Nikpoor P, van Eerd E, et al. Serial plotting on customised fundal height charts results in doubling of the antenatal detection of small for gestational age fetuses in nulliparous women. Aust N Z J Obstet Gynaecol 2012; 52:78.
  28. Mongelli M, Gardosi J. Symphysis-fundus height and pregnancy characteristics in ultrasound-dated pregnancies. Obstet Gynecol 1999; 94:591.
  29. Engstrom JL, Ostrenga KG, Plass RV, Work BA. The effect of maternal bladder volume on fundal height measurements. Br J Obstet Gynaecol 1989; 96:987.
  30. Hall MH, Chng PK, MacGillivray I. Is routine antenatal care worth while? Lancet 1980; 2:78.
  31. Bais JM, Eskes M, Pel M, et al. Effectiveness of detection of intrauterine growth retardation by abdominal palpation as screening test in a low risk population: an observational study. Eur J Obstet Gynecol Reprod Biol 2004; 116:164.
  32. Bricker L, Neilson JP, Dowswell T. Routine ultrasound in late pregnancy (after 24 weeks' gestation). Cochrane Database Syst Rev 2008; :CD001451.
  33. Harding K, Evans S, Newnham J. Screening for the small fetus: a study of the relative efficacies of ultrasound biometry and symphysiofundal height. Aust N Z J Obstet Gynaecol 1995; 35:160.
  34. Duncan KR, Issa B, Moore R, et al. A comparison of fetal organ measurements by echo-planar magnetic resonance imaging and ultrasound. BJOG 2005; 112:43.
  35. American College of Obstetricians and Gynecologists. ACOG Practice bulletin no. 134: fetal growth restriction. Obstet Gynecol 2013; 121:1122.
  36. Simon NV, O'Connor TJ 3rd, Shearer DM. Detection of intrauterine fetal growth retardation with abdominal circumference and estimated fetal weight using cross-sectional growth curves. J Clin Ultrasound 1990; 18:685.
  37. Hill LM, Guzick D, Belfar HL, et al. A combined historic and sonographic score for the detection of intrauterine growth retardation. Obstet Gynecol 1989; 73:291.
  38. Benson CB, Belville JS, Lentini JF, et al. Intrauterine growth retardation: diagnosis based on multiple parameters--a prospective study. Radiology 1990; 177:499.
  39. Roberts AB, Mitchell JM, McCowan LM, Barker S. Ultrasonographic measurement of liver length in the small-for-gestational-age fetus. Am J Obstet Gynecol 1999; 180:634.
  40. Senoh D, Hata T, Kitao M. Fetal liver length measurement does not provide a superior means for prediction of a small for gestational age fetus. Am J Perinatol 1994; 11:344.
  41. Snijders RJ, Nicolaides KH. Fetal biometry at 14-40 weeks' gestation. Ultrasound Obstet Gynecol 1994; 4:34.
  42. Brown HL, Miller JM Jr, Gabert HA, Kissling G. Ultrasonic recognition of the small-for-gestational-age fetus. Obstet Gynecol 1987; 69:631.
  43. Chang TC, Robson SC, Boys RJ, Spencer JA. Prediction of the small for gestational age infant: which ultrasonic measurement is best? Obstet Gynecol 1992; 80:1030.
  44. Owen P, Khan KS, Howie P. Single and serial estimates of amniotic fluid volume and umbilical artery resistance in the prediction of intrauterine growth restriction. Ultrasound Obstet Gynecol 1999; 13:415.
  45. Warsof SL, Cooper DJ, Little D, Campbell S. Routine ultrasound screening for antenatal detection of intrauterine growth retardation. Obstet Gynecol 1986; 67:33.
  46. Chambers SE, Hoskins PR, Haddad NG, et al. A comparison of fetal abdominal circumference measurements and Doppler ultrasound in the prediction of small-for-dates babies and fetal compromise. Br J Obstet Gynaecol 1989; 96:803.
  47. Ferrazzi E, Nicolini U, Kustermann A, Pardi G. Routine obstetric ultrasound: effectiveness of cross-sectional screening for fetal growth retardation. J Clin Ultrasound 1986; 14:17.
  48. Mongelli M, Ek S, Tambyrajia R. Screening for fetal growth restriction: a mathematical model of the effect of time interval and ultrasound error. Obstet Gynecol 1998; 92:908.
  49. Hecher K, Snijders R, Campbell S, Nicolaides K. Fetal venous, intracardiac, and arterial blood flow measurements in intrauterine growth retardation: relationship with fetal blood gases. Am J Obstet Gynecol 1995; 173:10.
  50. Hadlock FP. Sonographic estimation of fetal age and weight. Radiol Clin North Am 1990; 28:39.
  51. David C, Tagliavini G, Pilu G, et al. Receiver-operator characteristic curves for the ultrasonographic prediction of small-for-gestational-age fetuses in low-risk pregnancies. Am J Obstet Gynecol 1996; 174:1037.
  52. Campbell S, Wilkin D. Ultrasonic measurement of fetal abdomen circumference in the estimation of fetal weight. Br J Obstet Gynaecol 1975; 82:689.
  53. Shepard MJ, Richards VA, Berkowitz RL, et al. An evaluation of two equations for predicting fetal weight by ultrasound. Am J Obstet Gynecol 1982; 142:47.
  54. Ott WJ, Doyle S, Flamm S, Wittman J. Accurate ultrasonic estimation of fetal weight. Prospective analysis of new ultrasonic formulas. Am J Perinatol 1986; 3:307.
  55. Vintzileos AM, Campbell WA, Rodis JF, et al. Fetal weight estimation formulas with head, abdominal, femur, and thigh circumference measurements. Am J Obstet Gynecol 1987; 157:410.
  56. Hadlock FP: Evaluation of fetal weight estimation procedures. In: Quantitative Obstetrical Ultrasonography, Deter, RL (Ed), Wiley Medical, New York, 1986.
  57. Guidetti DA, Divon MY, Braverman JJ, et al. Sonographic estimates of fetal weight in the intrauterine growth retardation population. Am J Perinatol 1990; 7:5.
  58. Ott WJ, Doyle S. Ultrasonic diagnosis of altered fetal growth by use of a normal ultrasonic fetal weight curve. Obstet Gynecol 1984; 63:201.
  59. Divon MY, Guidetti DA, Braverman JJ, et al. Intrauterine growth retardation--a prospective study of the diagnostic value of real-time sonography combined with umbilical artery flow velocimetry. Obstet Gynecol 1988; 72:611.
  60. Palo P, Erkkola R, Piiroinen O, Ruotsalainen P. Accuracy of ultrasonic fetal weight estimation and detection of small for gestational age fetuses. Am J Perinatol 1989; 6:400.
  61. Baschat AA, Weiner CP. Umbilical artery doppler screening for detection of the small fetus in need of antepartum surveillance. Am J Obstet Gynecol 2000; 182:154.
  62. Unterscheider J, Daly S, Geary MP, et al. Optimizing the definition of intrauterine growth restriction: the multicenter prospective PORTO Study. Am J Obstet Gynecol 2013; 208:290.e1.
  63. Gardosi J, Mongelli M, Wilcox M, Chang A. An adjustable fetal weight standard. Ultrasound Obstet Gynecol 1995; 6:168.
  64. Gardosi J, Francis A. A customized standard to assess fetal growth in a US population. Am J Obstet Gynecol 2009; 201:25.e1.
  65. Carberry AE, Gordon A, Bond DM, et al. Customised versus population-based growth charts as a screening tool for detecting small for gestational age infants in low-risk pregnant women. Cochrane Database Syst Rev 2014; 5:CD008549.
  66. Clausson B, Gardosi J, Francis A, Cnattingius S. Perinatal outcome in SGA births defined by customised versus population-based birthweight standards. BJOG 2001; 108:830.
  67. de Jong CL, Gardosi J, Dekker GA, et al. Application of a customised birthweight standard in the assessment of perinatal outcome in a high risk population. Br J Obstet Gynaecol 1998; 105:531.
  68. McCowan LM, Harding JE, Stewart AW. Customized birthweight centiles predict SGA pregnancies with perinatal morbidity. BJOG 2005; 112:1026.
  69. De Jong CL, Francis A, Van Geijn HP, Gardosi J. Customized fetal weight limits for antenatal detection of fetal growth restriction. Ultrasound Obstet Gynecol 2000; 15:36.
  70. Sciscione AC, Gorman R, Callan NA. Adjustment of birth weight standards for maternal and infant characteristics improves the prediction of outcome in the small-for-gestational-age infant. Am J Obstet Gynecol 1996; 175:544.
  71. Groom KM, Poppe KK, North RA, McCowan LM. Small-for-gestational-age infants classified by customized or population birthweight centiles: impact of gestational age at delivery. Am J Obstet Gynecol 2007; 197:239.e1.
  72. Gardosi J, Francis A. Adverse pregnancy outcome and association with small for gestational age birthweight by customized and population-based percentiles. Am J Obstet Gynecol 2009; 201:28.e1.
  73. Ego A, Subtil D, Grange G, et al. Customized versus population-based birth weight standards for identifying growth restricted infants: a French multicenter study. Am J Obstet Gynecol 2006; 194:1042.
  74. Landres IV, Clark A, Chasen ST. Improving antenatal prediction of small-for-gestational-age neonates by using customized versus population-based reference standards. J Ultrasound Med 2013; 32:1581.
  75. Hutcheon JA, Zhang X, Cnattingius S, et al. Customised birthweight percentiles: does adjusting for maternal characteristics matter? BJOG 2008; 115:1397.
  76. Zhang X, Platt RW, Cnattingius S, et al. The use of customised versus population-based birthweight standards in predicting perinatal mortality. BJOG 2007; 114:474.
  77. Larkin JC, Hill LM, Speer PD, Simhan HN. Risk of morbid perinatal outcomes in small-for-gestational-age pregnancies: customized compared with conventional standards of fetal growth. Obstet Gynecol 2012; 119:21.
  78. Neta G, Grewal J, Mikolajczyk R, et al. Does the individualized reference outperform a simple ultrasound-based reference applied to birth weight in predicting child neurodevelopment? Ultrasound Obstet Gynecol 2011; 38:62.
  79. de Jong CL, Francis A, van Geijn HP, Gardosi J. Fetal growth rate and adverse perinatal events. Ultrasound Obstet Gynecol 1999; 13:86.
  80. Divon MY, Chamberlain PF, Sipos L, et al. Identification of the small for gestational age fetus with the use of gestational age-independent indices of fetal growth. Am J Obstet Gynecol 1986; 155:1197.
  81. Campbell S, Thoms A. Ultrasound measurement of the fetal head to abdomen circumference ratio in the assessment of growth retardation. Br J Obstet Gynaecol 1977; 84:165.
  82. Crane JP, Kopta MM. Prediction of intrauterine growth retardation via ultrasonically measured head/abdominal circumference ratios. Obstet Gynecol 1979; 54:597.
  83. Hadlock FP, Deter RL, Harrist RB, et al. A date-independent predictor of intrauterine growth retardation: femur length/abdominal circumference ratio. AJR Am J Roentgenol 1983; 141:979.
  84. Benson CB, Doubilet PM, Saltzman DH, Jones TB. FL/AC ratio: poor predictor of intrauterine growth retardation. Invest Radiol 1985; 20:727.
  85. Shalev E, Romano S, Weiner E, Ben-Ami M. Predictive value of the femur length to abdominal circumference ratio in the diagnosis of intrauterine growth retardation. Isr J Med Sci 1991; 27:131.
  86. Weiner CP, Robinson D. Sonographic diagnosis of intrauterine growth retardation using the postnatal ponderal index and the crown-heel length as standards of diagnosis. Am J Perinatol 1989; 6:380.
  87. Vintzileos AM, Lodeiro JG, Feinstein SJ, et al. Value of fetal ponderal index in predicting growth retardation. Obstet Gynecol 1986; 67:584.
  88. Reece EA, Goldstein I, Pilu G, Hobbins JC. Fetal cerebellar growth unaffected by intrauterine growth retardation: a new parameter for prenatal diagnosis. Am J Obstet Gynecol 1987; 157:632.
  89. Campbell WA, Nardi D, Vintzileos AM, et al. Transverse cerebellar diameter/abdominal circumference ratio throughout pregnancy: a gestational age-independent method to assess fetal growth. Obstet Gynecol 1991; 77:893.
  90. Dilmen G, Toppare MF, Turhan NO, et al. Transverse cerebellar diameter and transverse cerebellar diameter/ abdominal circumference index for assessing fetal growth. Fetal Diagn Ther 1996; 11:50.
  91. Campbell WA, Vintzileos AM, Rodis JF, et al. Use of the transverse cerebellar diameter/abdominal circumference ratio in pregnancies at risk for intrauterine growth retardation. J Clin Ultrasound 1994; 22:497.
  92. Meyer WJ, Gauthier D, Ramakrishnan V, Sipos J. Ultrasonographic detection of abnormal fetal growth with the gestational age-independent, transverse cerebellar diameter/abdominal circumference ratio. Am J Obstet Gynecol 1994; 171:1057.
  93. Hill LM, Guzick D, DiNofrio D, et al. Ratios between the abdominal circumference, head circumference, or femur length and the transverse cerebellar diameter of the growth-retarded and macrosomic fetus. Am J Perinatol 1994; 11:144.
  94. Nicolaides KH, Peters MT, Vyas S, et al. Relation of rate of urine production to oxygen tension in small-for-gestational-age fetuses. Am J Obstet Gynecol 1990; 162:387.
  95. Veille JC, Kanaan C. Duplex Doppler ultrasonographic evaluation of the fetal renal artery in normal and abnormal fetuses. Am J Obstet Gynecol 1989; 161:1502.
  96. Chauhan SP, Magann EF, Dohrety DA, et al. Prediction of small for gestational age newborns using ultrasound estimated and actual amniotic fluid volume: published data revisited. Aust N Z J Obstet Gynaecol 2008; 48:160.
  97. Patterson RM, Prihoda TJ, Pouliot MR. Sonographic amniotic fluid measurement and fetal growth retardation: a reappraisal. Am J Obstet Gynecol 1987; 157:1406.
  98. Manning FA, Hill LM, Platt LD. Qualitative amniotic fluid volume determination by ultrasound: antepartum detection of intrauterine growth retardation. Am J Obstet Gynecol 1981; 139:254.
  99. Chamberlain PF, Manning FA, Morrison I, et al. Ultrasound evaluation of amniotic fluid volume. I. The relationship of marginal and decreased amniotic fluid volumes to perinatal outcome. Am J Obstet Gynecol 1984; 150:245.
  100. Hill LM, Guzick D, Thomas ML, et al. Thigh circumference in the detection of intrauterine growth retardation. Am J Perinatol 1989; 6:349.
  101. Abramowicz JS, Sherer DM, Bar-Tov E, Woods JR Jr. The cheek-to-cheek diameter in the ultrasonographic assessment of fetal growth. Am J Obstet Gynecol 1991; 165:846.
  102. Hill LM, Guzick D, Boyles D, et al. Subcutaneous tissue thickness cannot be used to distinguish abnormalities of fetal growth. Obstet Gynecol 1992; 80:268.
  103. Gardeil F, Greene R, Stuart B, Turner MJ. Subcutaneous fat in the fetal abdomen as a predictor of growth restriction. Obstet Gynecol 1999; 94:209.
  104. Todros T, Sciarrone A, Piccoli E, et al. Umbilical Doppler waveforms and placental villous angiogenesis in pregnancies complicated by fetal growth restriction. Obstet Gynecol 1999; 93:499.
  105. Society for Maternal-Fetal Medicine Publications Committee, Berkley E, Chauhan SP, Abuhamad A. Doppler assessment of the fetus with intrauterine growth restriction. Am J Obstet Gynecol 2012; 206:300.
  106. Khong TY, De Wolf F, Robertson WB, Brosens I. Inadequate maternal vascular response to placentation in pregnancies complicated by pre-eclampsia and by small-for-gestational age infants. Br J Obstet Gynaecol 1986; 93:1049.
  107. Lin S, Shimizu I, Suehara N, et al. Uterine artery Doppler velocimetry in relation to trophoblast migration into the myometrium of the placental bed. Obstet Gynecol 1995; 85:760.
  108. Matijevic R, Johnston T. In vivo assessment of failed trophoblastic invasion of the spiral arteries in pre-eclampsia. Br J Obstet Gynaecol 1999; 106:78.
  109. Schulman H, Fleischer A, Farmakides G, et al. Development of uterine artery compliance in pregnancy as detected by Doppler ultrasound. Am J Obstet Gynecol 1986; 155:1031.
  110. Valcamonico A, Danti L, Frusca T, et al. Absent end-diastolic velocity in umbilical artery: risk of neonatal morbidity and brain damage. Am J Obstet Gynecol 1994; 170:796.
  111. Papageorghiou AT, Yu CK, Nicolaides KH. The role of uterine artery Doppler in predicting adverse pregnancy outcome. Best Pract Res Clin Obstet Gynaecol 2004; 18:383.
  112. Chien PF, Arnott N, Gordon A, et al. How useful is uterine artery Doppler flow velocimetry in the prediction of pre-eclampsia, intrauterine growth retardation and perinatal death? An overview. BJOG 2000; 107:196.
  113. Dugoff L, Lynch AM, Cioffi-Ragan D, et al. First trimester uterine artery Doppler abnormalities predict subsequent intrauterine growth restriction. Am J Obstet Gynecol 2005; 193:1208.
  114. Berkowitz GS, Chitkara U, Rosenberg J, et al. Sonographic estimation of fetal weight and Doppler analysis of umbilical artery velocimetry in the prediction of intrauterine growth retardation: a prospective study. Am J Obstet Gynecol 1988; 158:1149.
  115. Ott WJ. Comparison of dynamic image and pulsed Doppler ultrasonography for the diagnosis of intrauterine growth retardation. J Clin Ultrasound 1990; 18:3.
  116. Baschat AA. Pathophysiology of fetal growth restriction: implications for diagnosis and surveillance. Obstet Gynecol Surv 2004; 59:617.
  117. Morris RK, Malin G, Robson SC, et al. Fetal umbilical artery Doppler to predict compromise of fetal/neonatal wellbeing in a high-risk population: systematic review and bivariate meta-analysis. Ultrasound Obstet Gynecol 2011; 37:135.
  118. Burke G, Stuart B, Crowley P, et al. Is intrauterine growth retardation with normal umbilical artery blood flow a benign condition? BMJ 1990; 300:1044.
  119. Pattinson RC, Norman K, Odendaal HJ. The role of Doppler velocimetry in the management of high risk pregnancies. Br J Obstet Gynaecol 1994; 101:114.
  120. McCowan LM, Harding JE, Stewart AW. Umbilical artery Doppler studies in small for gestational age babies reflect disease severity. BJOG 2000; 107:916.
  121. Soothill PW, Nicolaides KH, Bilardo CM, Campbell S. Relation of fetal hypoxia in growth retardation to mean blood velocity in the fetal aorta. Lancet 1986; 2:1118.
  122. Jouppila P, Kirkinen P. Blood velocity waveforms of the fetal aorta in normal and hypertensive pregnancies. Obstet Gynecol 1986; 67:856.
  123. Laurin J, Lingman G, Marsál K, Persson PH. Fetal blood flow in pregnancies complicated by intrauterine growth retardation. Obstet Gynecol 1987; 69:895.
  124. Hackett GA, Campbell S, Gamsu H, et al. Doppler studies in the growth retarded fetus and prediction of neonatal necrotising enterocolitis, haemorrhage, and neonatal morbidity. Br Med J (Clin Res Ed) 1987; 294:13.
  125. Arabin B, Siebert M, Jimenez E, Saling E. Obstetrical characteristics of a loss of end-diastolic velocities in the fetal aorta and/or umbilical artery using Doppler ultrasound. Gynecol Obstet Invest 1988; 25:173.
  126. Tonge HM, Wladimiroff JW, Noordam MJ, van Kooten C. Blood flow velocity waveforms in the descending fetal aorta: comparison between normal and growth-retarded pregnancies. Obstet Gynecol 1986; 67:851.
  127. Bonatz G, Schulz V, Weisner D, Jonat W. Fetal heart rate (FHR) pathology in labor related to preceeding Doppler sonographic results of the umbilical artery and fetal aorta in appropriate and small for gestational age babies. A longitudinal analysis. J Perinat Med 1997; 25:440.
  128. Marsál K, Laurin J, Lindblad A, Lingman G. Blood flow in the fetal descending aorta. Semin Perinatol 1987; 11:322.
  129. Jouppila P, Kirkinen P. Noninvasive assessment of fetal aortic blood flow in normal and abnormal pregnancies. Clin Obstet Gynecol 1989; 32:703.
  130. Vyas S, Nicolaides KH, Campbell S. Renal artery flow-velocity waveforms in normal and hypoxemic fetuses. Am J Obstet Gynecol 1989; 161:168.
  131. Arduini D, Rizzo G. Fetal renal artery velocity waveforms and amniotic fluid volume in growth-retarded and post-term fetuses. Obstet Gynecol 1991; 77:370.
  132. Yoshimura S, Masuzaki H, Gotoh H, Ishimaru T. Fetal redistribution of blood flow and amniotic fluid volume in growth-retarded fetuses. Early Hum Dev 1997; 47:297.
  133. Arabin B, Bergmann PL, Saling E. Simultaneous assessment of blood flow velocity waveforms in uteroplacental vessels, the umbilical artery, the fetal aorta and the fetal common carotid artery. Fetal Ther 1987; 2:17.
  134. Wladimiroff JW, Noordam MJ, van den Wijngaard JA, Hop WC. Fetal internal carotid and umbilical artery blood flow velocity waveforms as a measure of fetal well-being in intrauterine growth retardation. Pediatr Res 1988; 24:609.
  135. Strigini FA, De Luca G, Lencioni G, et al. Middle cerebral artery velocimetry: different clinical relevance depending on umbilical velocimetry. Obstet Gynecol 1997; 90:953.
  136. Fong KW, Ohlsson A, Hannah ME, et al. Prediction of perinatal outcome in fetuses suspected to have intrauterine growth restriction: Doppler US study of fetal cerebral, renal, and umbilical arteries. Radiology 1999; 213:681.
  137. Gramellini D, Folli MC, Raboni S, et al. Cerebral-umbilical Doppler ratio as a predictor of adverse perinatal outcome. Obstet Gynecol 1992; 79:416.
  138. Ploeckinger-Ulm B, Ulm MR, Lee A, et al. Antenatal depiction of fetal digits with three-dimensional ultrasonography. Am J Obstet Gynecol 1996; 175:571.
  139. Mueller GM, Weiner CP, Yankowitz J. Three-dimensional ultrasound in the evaluation of fetal head and spine anomalies. Obstet Gynecol 1996; 88:372.
  140. Schild RL, Wallny T, Fimmers R, Hansmann M. Fetal lumbar spine volumetry by three-dimensional ultrasound. Ultrasound Obstet Gynecol 1999; 13:335.
  141. Lee A, Kratochwil A, Stümpflen I, et al. Fetal lung volume determination by three-dimensional ultrasonography. Am J Obstet Gynecol 1996; 175:588.
  142. Chang FM, Hsu KF, Ko HC, et al. Three-dimensional ultrasound assessment of fetal liver volume in normal pregnancy: a comparison of reproducibility with two-dimensional ultrasound and a search for a volume constant. Ultrasound Med Biol 1997; 23:381.
  143. Liang RI, Chang FM, Yao BL, et al. Predicting birth weight by fetal upper-arm volume with use of three-dimensional ultrasonography. Am J Obstet Gynecol 1997; 177:632.
  144. Chang FM, Liang RI, Ko HC, et al. Three-dimensional ultrasound-assessed fetal thigh volumetry in predicting birth weight. Obstet Gynecol 1997; 90:331.
  145. Song TB, Moore TR, Lee JI, et al. Fetal weight prediction by thigh volume measurement with three-dimensional ultrasonography. Obstet Gynecol 2000; 96:157.
  146. Chang CH, Tsai PY, Yu CH, et al. Prenatal detection of fetal growth restriction by fetal femur volume: efficacy assessment using three-dimensional ultrasound. Ultrasound Med Biol 2007; 33:335.
  147. Chang CH, Yu CH, Ko HC, et al. Predicting fetal growth restriction by humerus volume: A three-dimensional ultrasound study. Ultrasound Med Biol 2006; 32:791.
  148. Chang CH, Yu CH, Ko HC, et al. The efficacy assessment of thigh volume in predicting intrauterine fetal growth restriction by three-dimensional ultrasound. Ultrasound Med Biol 2005; 31:883.