Fetal growth restriction: Evaluation
Fetal growth restriction: Evaluation
Giancarlo Mari, MD, MBA
Section Editor:
Charles J Lockwood, MD, MHCM
Deputy Editor:
Vanessa A Barss, MD, FACOG
Literature review current through: Mar 2024.
This topic last updated: Mar 19, 2024.


Fetal growth restriction (FGR) is broadly defined as an estimated fetal weight (EFW) or abdominal circumference (AC) <10th percentile for gestational age. Severe FGR is generally defined as an EFW or AC <3rd percentile for gestational age; the presence of fetal umbilical artery (UA) Doppler abnormalities also suggests that FGR is severe. However, sonographic criteria for diagnosis of FGR vary (table 1) [1-3]. None of these criteria is ideal for identification of FGR as all have poor performance for predicting adverse neonatal outcome [4]. (See "Fetal growth restriction: Screening and diagnosis", section on 'Diagnosis'.)

Identification of FGR is an integral component of prenatal care as it is a leading cause of perinatal morbidity and mortality [5]. When FGR is suspected, the obstetric provider needs to confirm the suspected diagnosis, determine the probable cause, assess the severity, counsel the parents, closely monitor fetal growth and well-being for the remainder of the pregnancy, and determine the optimal time for and route of birth. Although FGR is not a homogeneous entity, uteroplacental insufficiency with suboptimal fetal nutrition and hypoperfusion is a common pathway to many forms of FGR. It can be present in patients with pregnancy-associated hypertension, chronic hypertension, chronic kidney disease, maternal or fetal infection, diabetes with vasculopathy, and fetal aneuploidy. In these cases, the fetus is closely monitored to identify those who are at highest risk of perinatal demise and thus may benefit from early delivery.

This topic will discuss the evaluation of FGR in singleton pregnancies. Pregnancy management and outcome are reviewed separately. (See "Fetal growth restriction: Pregnancy management and outcome".)

FGR in twin pregnancies is also reviewed separately. (See "Twin pregnancy: Routine prenatal care", section on 'Screening for fetal growth restriction and discordance' and "Selective fetal growth restriction in monochorionic twin pregnancies".)


The diagnosis of FGR is established sonographically (see "Fetal growth restriction: Screening and diagnosis"). The pregnancy is then evaluated to determine whether fetal growth is impaired as a result of maternal, fetal, or placental processes (table 2). However, this determination cannot always be made antenatally, despite the following evaluation. When no maternal and/or fetal predisposing factors are found, FGR may be termed idiopathic or isolated [6,7].

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