Fetal Growth Restriction (FGR)

WHAT IS IT?

Fetal growth restriction (FGR)/Intrauterine growth restriction (IUGR) is a term whose criteria are often inconsistent. With this in mind, FGR can often refer to:

• Fetus with estimated weight < 10th percentile for gestational age
• Fetus with growth compromised by abnormal or pathological process (compared to constitutionally small fetus)

WHAT CAUSES IT?

This condition can often be an idiopatic complication of preganncy. With this in mind, it is beleived that some element of poor perfusion/poor nutriiton to the fetus is responsible for causing restricted growth. This can be secondary to a:

• Abnormal fetal karyotype: such as trisomy 21
• Abnormal placentation
• Complication of pregnancy: such as hypertensive complciations
• Intrauterine infections such as those causes by cytomegalovirus

WHY IS IT A PROBLEM?

Fundamentally a fetus that is not growing (receiving proper nutrition) is an ominous sign, and the life of the fetus may be in danger due to this condition.

WHAT MAKES US SUSPECT IT?

Risk factors

Prior FGR pregnancy, malnutrition, hypertensive disorders of pregnancy

Initial Presentation

• Smaller then expected fundus height during pregnancy visits
• Decreasing serial fetal weight measurements

History Of Present Illness

Poor maternal weight gain may be a point of history observed in women with FGR.

Physical Exam Findings

Abdominal exam:

• Decreased symphysis fundal height: discrepancy of ≥ 3 between gestational age and symphysis fundal height measurements can raise suspicions.

CLINICAL WORKUP

Ultrasound assessment of fetal biometry:

• Commonly a fetus with estimated weight < 10th percentile for gestational age is used as the parameter for making the diagnosis.

AT WHAT POINT DO WE FEEL CONFIDENT IN MAKING THE DIAGNOSIS?

WHAT ELSE ARE WE WORRIED ABOUT?

HOW DO WE TREAT IT? 

HOW WELL DO THE PATIENTS DO?

WAS THERE A WAY TO PREVENT IT?

OTHER FACTS?

FURTHER READING

DynaMed

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Page Updated: 09.07.2016