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Fetal growth restriction: Diagnosis

Michael Y Divon, MD
Section Editor
Deborah Levine, MD
Deputy Editor
Vanessa A Barss, MD, FACOG


Fetal growth restriction (FGR, also called intrauterine growth restriction [IUGR]) is the term used to describe a fetus that has not reached its growth potential because of genetic or environmental factors. The origin may be fetal, placental, or maternal, with significant overlap among these entities.

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. This is important because these fetuses are at increased risk of adverse perinatal outcome. In addition, FGR appears to be an antecedent to some cases of hypertension, hyperlipidemia, coronary heart disease, and diabetes mellitus in the adult (Barker hypothesis). (See "Infants with fetal (intrauterine) growth restriction" and "Possible role of low birth weight in the pathogenesis of primary (essential) hypertension".)

Prenatal screening for 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. (See "Fetal growth restriction: Evaluation and management", section on 'Determine the cause'.)

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. When a small fetus is detected, it can be difficult to distinguish between the fetus that is constitutionally small versus growth restricted. It is also difficult to identify the fetus that is not small but growth restricted relative to its genetic potential. Making the correct diagnosis is not always possible, but is important prognostically and for estimating the risk for recurrence.

Ideally, prenatal detection of FGR will provide an opportunity to employ interventions to reduce the morbidity and mortality associated with this problem. Although stillbirth rates are higher when FGR is not detected antenatally [1], there is only low quality evidence that antenatal identification of FGR improves outcome [2]. 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 remains a challenge. These issues need to be addressed by large multicenter studies employing consistent definitions, randomly assigned interventions, and with long-term follow-up.

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Literature review current through: Nov 2017. | This topic last updated: Feb 07, 2017.
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