Abstract
An accurate diagnosis of fetal growth restriction relies on a precise estimation of
gestational age based on a carefully obtained history as well as early ultrasound,
since a difference of just a few days can lead to a significant error. There is a
continuum of risk for adverse outcome that depends on the certainty of dates and presence
or absence of comorbidities, in addition to the estimated fetal weight percentile
and the umbilical artery waveform. The results of several studies, most notably the
TRUFFLE trial, demonstrate that optimal management of fetal growth restriction with
an abnormal umbilical artery waveform requires daily electronic fetal heart rate monitoring,
and this monitoring does not require computerized interpretation. The role of ductus
venosus waveform, biophysical profile, and middle cerebral artery waveform is less
clear, and the results of these three modalities should be interpreted with caution.
Key Points
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A correct diagnosis of fetal growth restriction requires a very precise estimate of
gestational age.
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In the presence of abnormal umbilical artery Doppler, the cornerstone of surveillance
is daily electronic fetal heart rate monitoring.
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Surveillance with biophysical profile, ductus venosus waveform, and middle cerebral
artery waveform are less important than daily electronic fetal heart rate monitoring.
Keywords
fetal growth restriction - ductus venosus waveform - feta heart rate monitoring -
biophysical profile - middle cerebral artery waveform
