Current practice in the diagnosis and management of fetal growth restriction: An international survey

Abstract

Introduction:The aim of this survey was to evaluate the current practice in respect of diagnosis and management of fetal growth restriction among obstetricians in different countries.Material and methods: An e-questionnaire was sent via REDCap with "click thru" links in emails and newsletters to obstetric practitioners in different countries and settings with different levels of expertise. Clinical scenarios in early and late fetal growth restriction were given, followed by structured questions/response pairings. Results: A total of 275 participants replied to the survey with 87% of responses complete. Participants were obstetrician/gynecologists (54%; 148/275) and fetal medicine specialists (43%; 117/275), and the majority practiced in a tertiary teaching hospital (56%; 153/275). Delphi consensus criteria for fetal growth restriction diagnosis were used by 81% of participants (223/275) and 82% (225/274) included a drop in fetal growth velocity in their diagnostic criteria for late fetal growth restriction. For early fetal growth restriction, TRUFFLE criteria were used for fetal monitoring and delivery timing by 81% (223/275). For late fetal growth restriction, indices of cerebral blood flow redistribution were used by 99% (250/252), most commonly cerebroplacental ratio (54%, 134/250). Delivery timing was informed by cerebral blood flow redistribution in 72% (176/244), used from ≥32 weeks of gestation. Maternal biomarkers and hemodynamics, as additional tools in the context of early-onset fetal growth restriction (≤32 weeks of gestation), were used by 22% (51/232) and 46% (106/230), respectively. Conclusions: The diagnosis and management of fetal growth restriction are fairly homogeneous among different countries and levels of practice, particularly for early fetal growth restriction. Indices of cerebral flow distribution are widely used in the diagnosis and management of late fetal growth restriction, whereas maternal biomarkers and hemodynamics are less frequently assessed but more so in early rather than

Outcome‐based comparative analysis of five fetal growth velocity models to define slow growth

“…The two-quartile (FCD 50 ) drop in fetal growth velocity, in conjunction with SGA (< 10 th centile EFW or abdominal circumference) and/or abnormal Doppler, stems from a Delphi consensus definition of FGR 16 , which has since been adopted by ISUOG 17 and FIGO 18 practice guidelines. A recent international survey of obstetricians found that this definition of slow growth was used by over 80% of respondents as a diagnostic criterion for late-onset growth restriction 34 . In the study by MacDonald and colleagues 19 , a > 50 centile drop between 28 and 36 weeks' gestation was observed in only 2.6% of cases, and in our cohort, with an average measurement interval of 3-4 weeks, the incidence was even less (0.7%).…”

Intrauterine Growth Restriction: Need to Improve Diagnostic Accuracy and Evidence for a Key Role of Oxidative Stress in Neonatal and Long-Term Sequelae

“…Most importantly, intrauterine growth restriction (IUGR) and being small for gestational age (SGA) are two distinct conditions [5][6][7] with different implications for child development. While being born SGA below the tenth percentile may be physiological (e.g., when both parents are small), IUGR indicates a pathophysiology during pregnancy [8]. According to the international Delphi consensus, the diagnosis of IUGR in fetuses below the tenth percentile of estimated fetal weight (EFW) and/or abdominal circumference (AC) should take both decelerating fetal growth trajectories and abnormal Doppler findings into account [7].…”

Intrauterine Growth Restriction: Improving Diagnostic Accuracy and the Role of Oxidative Stress in Neonatal and Long-Term Sequels

“…While being born SGA below the 10 th percentile may be physiological (e.g., when both parents are small), IUGR indicates a pathophysiology during pregnancy [8]. According to international Delphi consensus, the diagnosis of IUGR in fetuses below the 10 th percentile of estimated fetal weight (EFW) should include both abnormal fetal sizes compared to the respective trajectories and abnormal Doppler findings [7].…”