Fetal Growth Restriction (IUGR): Diagnosis, Monitoring, and Delivery Timing

Definition

IUGR/FGR: estimated fetal weight <10th percentile for gestational age.

Etiologies

• Maternal: hypertension, diabetes, autoimmune, smoking, malnutrition.
• Placental: infarction, abruption, previa, abnormal umbilical artery Doppler.
• Fetal: aneuploidy, congenital infection, structural anomalies.

Surveillance

• Serial ultrasounds (growth, AFI, Doppler UA/MCA/DV).
• NST/BPP 1–2×/week.
• Maternal BP, labs.

Delivery Indications

• Absent/reversed end‑diastolic flow in UA.
• Reversed A‑wave in ductus venosus.
• Non‑reassuring testing, oligohydramnios, maternal deterioration.
• ≥37 weeks with confirmed FGR → deliver.
• <34 weeks: corticosteroids + expectant management if stable.

Multidisciplinary team (MFM, neonatology) optimizes timing.