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Obstetrics
Diagnosis
Fluid, Growth, and Well-Being
Fetal Growth Restriction
Fetal Growth Restriction
Roya Sohaey, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Fetal growth restriction (FGR)

          • Synonyms

            • Intrauterine growth restriction (IUGR)

          • Definitions

            • Estimated fetal weight (EFW) < 10th percentile for gestational age (GA)
              • Asymmetric FGR: Small abdominal circumference (AC) compared with head circumference (HC)
              • Symmetric FGR: Uniformly small
            • Small for gestational age (SGA) is not always FGR
              • SGA: Fetus is small but healthy, not growth restricted
              • FGR: Fetus is pathologically small, growth restricted
                • Not reaching full growth potential

          IMAGING

          • General Features

            • Ultrasonographic Findings

              • Imaging Recommendations

                DIFFERENTIAL DIAGNOSIS

                  PATHOLOGY

                  • General Features

                    CLINICAL ISSUES

                    • Presentation

                      • Demographics

                        • Natural History & Prognosis

                          • Treatment

                            DIAGNOSTIC CHECKLIST

                            • Consider

                              • Image Interpretation Pearls

                                • Reporting Tips

                                  Selected References

                                  1. Kovo M et al: Pregnancy outcome and placental findings in pregnancies complicated by fetal growth restriction with and without preeclampsia. Reprod Sci. 22(3):316-21, 2015
                                  2. Maggio L et al: Perinatal outcomes with normal compared with elevated umbilical artery systolic-to-diastolic ratios in fetal growth restriction. Obstet Gynecol. 125(4):863-9, 2015
                                  3. Sovio U et al: Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study. Lancet. 386(10008):2089-97, 2015
                                  4. Zhang J et al: Defining normal and abnormal fetal growth: promises and challenges. Am J Obstet Gynecol. 202(6):522-8, 2010
                                  5. Miller J et al: Fetal growth restriction. Semin Perinatol. 32(4):274-80, 2008
                                  6. Mäkikallio K et al: Human fetal cardiovascular profile score and neonatal outcome in intrauterine growth restriction. Ultrasound Obstet Gynecol. 31(1):48-54, 2008
                                  7. Zuk L et al: Neonatal general movements: an early predictor for neurodevelopmental outcome in infants with intrauterine growth retardation. J Child Neurol. 19(1):14-8, 2004
                                  8. Rasmussen S et al: Fetal growth and body proportion in preeclampsia. Obstet Gynecol. 101(3):575-83, 2003
                                  9. Galan HL et al: Intrauterine growth restriction (IUGR): biometric and Doppler assessment. Prenat Diagn. 22(4):331-7, 2002
                                  10. Hofstaetter C et al: Venous Doppler velocimetry in the surveillance of severely compromised fetuses. Ultrasound Obstet Gynecol. 20(3):233-9, 2002
                                  11. Severi FM et al: Uterine and fetal cerebral Doppler predict the outcome of third-trimester small-for-gestational age fetuses with normal umbilical artery Doppler. Ultrasound Obstet Gynecol. 19(3):225-8, 2002
                                  12. Vergani P et al: Prognostic value of uterine artery Doppler velocimetry in growth-restricted fetuses delivered near term. Am J Obstet Gynecol. 187(4):932-6, 2002
                                  13. May R et al: Early postnatal growth of low birthweight infants in the WIC program. Am J Hum Biol. 13(2):261-7, 2001
                                  14. Dashe JS et al: Effects of symmetric and asymmetric fetal growth on pregnancy outcomes. Obstet Gynecol. 96(3):321-7, 2000
                                  15. Markestad T et al: Small-for-gestational-age (SGA) infants born at term: growth and development during the first year of life. Acta Obstet Gynecol Scand Suppl. 165:93-101, 1997
                                  16. Sherwood RJ et al: Pattern and process of growth of the abnormal human fetus. Hum Biol. 69(6):849-71, 1997
                                  17. Vik T et al: Body proportions and early neonatal morbidity in small-for-gestational-age infants of successive births. Acta Obstet Gynecol Scand Suppl. 165:76-81, 1997
                                  18. Vik T et al: Prenatal growth in symmetric and asymmetric small-for-gestational-age infants. Early Hum Dev. 48(1-2):167-76, 1997
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Top Differential Diagnoses

                                        • Clinical Issues

                                          TERMINOLOGY

                                          • Abbreviations

                                            • Fetal growth restriction (FGR)

                                          • Synonyms

                                            • Intrauterine growth restriction (IUGR)

                                          • Definitions

                                            • Estimated fetal weight (EFW) < 10th percentile for gestational age (GA)
                                              • Asymmetric FGR: Small abdominal circumference (AC) compared with head circumference (HC)
                                              • Symmetric FGR: Uniformly small
                                            • Small for gestational age (SGA) is not always FGR
                                              • SGA: Fetus is small but healthy, not growth restricted
                                              • FGR: Fetus is pathologically small, growth restricted
                                                • Not reaching full growth potential

                                          IMAGING

                                          • General Features

                                            • Ultrasonographic Findings

                                              • Imaging Recommendations

                                                DIFFERENTIAL DIAGNOSIS

                                                  PATHOLOGY

                                                  • General Features

                                                    CLINICAL ISSUES

                                                    • Presentation

                                                      • Demographics

                                                        • Natural History & Prognosis

                                                          • Treatment

                                                            DIAGNOSTIC CHECKLIST

                                                            • Consider

                                                              • Image Interpretation Pearls

                                                                • Reporting Tips

                                                                  Selected References

                                                                  1. Kovo M et al: Pregnancy outcome and placental findings in pregnancies complicated by fetal growth restriction with and without preeclampsia. Reprod Sci. 22(3):316-21, 2015
                                                                  2. Maggio L et al: Perinatal outcomes with normal compared with elevated umbilical artery systolic-to-diastolic ratios in fetal growth restriction. Obstet Gynecol. 125(4):863-9, 2015
                                                                  3. Sovio U et al: Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study. Lancet. 386(10008):2089-97, 2015
                                                                  4. Zhang J et al: Defining normal and abnormal fetal growth: promises and challenges. Am J Obstet Gynecol. 202(6):522-8, 2010
                                                                  5. Miller J et al: Fetal growth restriction. Semin Perinatol. 32(4):274-80, 2008
                                                                  6. Mäkikallio K et al: Human fetal cardiovascular profile score and neonatal outcome in intrauterine growth restriction. Ultrasound Obstet Gynecol. 31(1):48-54, 2008
                                                                  7. Zuk L et al: Neonatal general movements: an early predictor for neurodevelopmental outcome in infants with intrauterine growth retardation. J Child Neurol. 19(1):14-8, 2004
                                                                  8. Rasmussen S et al: Fetal growth and body proportion in preeclampsia. Obstet Gynecol. 101(3):575-83, 2003
                                                                  9. Galan HL et al: Intrauterine growth restriction (IUGR): biometric and Doppler assessment. Prenat Diagn. 22(4):331-7, 2002
                                                                  10. Hofstaetter C et al: Venous Doppler velocimetry in the surveillance of severely compromised fetuses. Ultrasound Obstet Gynecol. 20(3):233-9, 2002
                                                                  11. Severi FM et al: Uterine and fetal cerebral Doppler predict the outcome of third-trimester small-for-gestational age fetuses with normal umbilical artery Doppler. Ultrasound Obstet Gynecol. 19(3):225-8, 2002
                                                                  12. Vergani P et al: Prognostic value of uterine artery Doppler velocimetry in growth-restricted fetuses delivered near term. Am J Obstet Gynecol. 187(4):932-6, 2002
                                                                  13. May R et al: Early postnatal growth of low birthweight infants in the WIC program. Am J Hum Biol. 13(2):261-7, 2001
                                                                  14. Dashe JS et al: Effects of symmetric and asymmetric fetal growth on pregnancy outcomes. Obstet Gynecol. 96(3):321-7, 2000
                                                                  15. Markestad T et al: Small-for-gestational-age (SGA) infants born at term: growth and development during the first year of life. Acta Obstet Gynecol Scand Suppl. 165:93-101, 1997
                                                                  16. Sherwood RJ et al: Pattern and process of growth of the abnormal human fetus. Hum Biol. 69(6):849-71, 1997
                                                                  17. Vik T et al: Body proportions and early neonatal morbidity in small-for-gestational-age infants of successive births. Acta Obstet Gynecol Scand Suppl. 165:76-81, 1997
                                                                  18. Vik T et al: Prenatal growth in symmetric and asymmetric small-for-gestational-age infants. Early Hum Dev. 48(1-2):167-76, 1997
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