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Fetal growth restriction (FGR) is defined as failure of the fetus to achieve its genetically determined growth potential due to an underlying pathological process . FGR affects approximately 10% of all pregnancies and is a major determinant of perinatal and childhood mortality and morbidity, as well as chronic disease in adulthood [2–4]. A challenge in studying FGR is the lack of a gold standard definition and clear diagnostic criteria. Small for gestational age (SGA) is often used interchangeably with FGR but fails to differentiate between the constitutionally small but healthy fetus and the pathologically growth-restricted fetus. SGA is typically defined as a baby <10th centile, but 40% of these babies are physiologically small and healthy, therefore fetal size alone cannot be used to differentiate SGA from FGR. Assessment of functional parameters has been proposed to improve diagnostic accuracy but may still miss the larger baby (>10th centile) that is also in fact growth restricted. The importance of accurately diagnosing FGR is that it identifies the potential risk of fetal demise or perinatal complications, which may be averted via appropriate monitoring and optimized delivery.
The accurate diagnosis of intrauterine growth restriction (IUGR) is achieved using a combination of clinical examination, relevant laboratory tests, and a variety of ultrasound techniques, including detailed anatomical scanning, placental evaluation, and Doppler assessment of placental and fetal vessels. The risk factors for IUGR are increasing over time and these include increased maternal age, coexistent medical problems, and assisted reproductive technology. Fetal causes of IUGR may be classified according to genetic diseases, congenital malformations, infections, and multiple gestation. Once a diagnosis has been established, consideration of the need for further investigations, consultation, or advice from a regional perinatal center and ongoing maternal-fetal surveillance should be instituted. Management will be directed according to the presence or absence of uteroplacental vascular insufficiency. The optimal timing of delivery is currently the source of much controversy, due to the many relevant clinical and ultrasound factors that clinicians must consider, in addition to patient preferences.