Evidence-based national guidelines for the management of suspected fetal growth restriction: comparison, consensus, and controversy.

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dc.contributor.author McCowan, Lesley en
dc.contributor.author Figueras, Francesc en
dc.contributor.author Anderson, Ngaire en
dc.date.accessioned 2020-01-10T01:14:37Z en
dc.date.issued 2018-02 en
dc.identifier.citation American journal of obstetrics and gynecology 218(2S):S855-S868 Feb 2018 en
dc.identifier.issn 0002-9378 en
dc.identifier.uri http://hdl.handle.net/2292/49480 en
dc.description.abstract Small for gestational age is usually defined as an infant with a birthweight <10th centile for a population or customized standard. Fetal growth restriction refers to a fetus that has failed to reach its biological growth potential because of placental dysfunction. Small-for-gestational-age babies make up 28-45% of nonanomalous stillbirths, and have a higher chance of neurodevelopmental delay, childhood and adult obesity, and metabolic disease. The majority of small-for-gestational-age babies are not recognized before birth. Improved identification, accompanied by surveillance and timely delivery, is associated with reduction in small-for-gestational-age stillbirths. Internationally and regionally, detection of small for gestational age and management of fetal growth problems vary considerably. The aim of this review is to: summarize areas of consensus and controversy between recently published national guidelines on small for gestational age or fetal growth restriction; highlight any recent evidence that should be incorporated into existing guidelines; and identify future research priorities in this field. A search of MEDLINE, Google, and the International Guideline Library identified 6 national guidelines on management of pregnancies complicated by fetal growth restriction/small for gestational age published from 2010 onwards. There is general consensus between guidelines (at least 4 of 6 guidelines in agreement) in early pregnancy risk selection, and use of low-dose aspirin for women with major risk factors for placental insufficiency. All highlight the importance of smoking cessation to prevent small for gestational age. While there is consensus in recommending fundal height measurement in the third trimester, 3 specify the use of a customized growth chart, while 2 recommend McDonald rule. Routine third-trimester scanning is not recommended for small-for-gestational-age screening, while women with major risk factors should have serial scanning in the third trimester. Umbilical artery Doppler studies in suspected small-for-gestational-age pregnancies are universally advised, however there is inconsistency in the recommended frequency for growth scans after diagnosis of small for gestational age/fetal growth restriction (2-4 weekly). In late-onset fetal growth restriction (≥32 weeks) general consensus is to use cerebral Doppler studies to influence surveillance and/or delivery timing. Fetal surveillance methods (most recommend cardiotocography) and recommended timing of delivery vary. There is universal agreement on the use of corticosteroids before birth at <34 weeks, and general consensus on the use of magnesium sulfate for neuroprotection in early-onset fetal growth restriction (<32 weeks). Most guidelines advise using cardiotocography surveillance to plan delivery in fetal growth restriction <32 weeks. The recommended gestation at delivery for fetal growth restriction with absent and reversed end-diastolic velocity varies from 32 to ≥34 weeks and 30 to ≥34 weeks, respectively. Overall, where there is high-quality evidence from randomized controlled trials and meta-analyses, eg, use of umbilical artery Doppler and corticosteroids for delivery <34 weeks, there is a high degree of consistency between national small-for-gestational-age guidelines. This review discusses areas where there is potential for convergence between small-for-gestational-age guidelines based on existing randomized controlled trials of management of small-for-gestational-age pregnancies, and areas of controversy. Research priorities include assessing the utility of late third-trimester scanning to prevent major morbidity and mortality and to investigate the optimum timing of delivery in fetuses with late-onset fetal growth restriction and abnormal Doppler parameters. Prospective studies are needed to compare new international population ultrasound standards with those in current use. en
dc.format.medium Print en
dc.language eng en
dc.relation.ispartofseries American journal of obstetrics and gynecology en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. en
dc.rights.uri https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm en
dc.subject Umbilical Arteries en
dc.subject Humans en
dc.subject Fetal Growth Retardation en
dc.subject Placental Insufficiency en
dc.subject Aspirin en
dc.subject Platelet Aggregation Inhibitors en
dc.subject Ultrasonography, Doppler en
dc.subject Ultrasonography, Prenatal en
dc.subject Prenatal Care en
dc.subject Risk Assessment en
dc.subject Smoking Cessation en
dc.subject Consensus en
dc.subject Evidence-Based Medicine en
dc.subject Pregnancy en
dc.subject Infant, Newborn en
dc.subject Infant, Small for Gestational Age en
dc.subject Canada en
dc.subject United States en
dc.subject France en
dc.subject Ireland en
dc.subject New Zealand en
dc.subject Female en
dc.subject Practice Guidelines as Topic en
dc.subject Growth Charts en
dc.subject Biomarkers en
dc.subject United Kingdom en
dc.title Evidence-based national guidelines for the management of suspected fetal growth restriction: comparison, consensus, and controversy. en
dc.type Journal Article en
dc.identifier.doi 10.1016/j.ajog.2017.12.004 en
pubs.issue 2S en
pubs.begin-page S855 en
pubs.volume 218 en
dc.rights.holder Copyright: 2017 Published by Elsevier Inc. en
dc.identifier.pmid 29422214 en
pubs.end-page S868 en
pubs.publication-status Published en
dc.rights.accessrights http://purl.org/eprint/accessRights/RestrictedAccess en
pubs.subtype Comparative Study en
pubs.subtype Review en
pubs.subtype Journal Article en
pubs.elements-id 725735 en
pubs.org-id Medical and Health Sciences en
pubs.org-id School of Medicine en
pubs.org-id Obstetrics and Gynaecology en
dc.identifier.eissn 1097-6868 en
pubs.record-created-at-source-date 2018-02-10 en
pubs.dimensions-id 29422214 en

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