Subscribe to RSS
DOI: 10.1055/a-2535-0528
Fetal Growth Restriction. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry No. 015/080, October 2024)
Article in several languages: English | deutsch
Abstract
Purpose The purpose of this official guideline, updated and published by the German Society for Gynecology (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, DGGG) and coordinated by the joint guidelines program of the DGGG, Austrian Society for Gynecology and Obstetrics (Österreichische Gesellschaft für Gynäkologie und Geburtshilfe, OEGGG) and Swiss Society for Gynecology and Obstetrics (Schweizerische Gesellschaft für Gynäkologie und Geburtshilfe, SGGG) is to provide a consensus-based overview of the diagnosis and management of intrauterine growth restriction based on an evaluation of the relevant literature.
Methods This S2k-guideline is the result of a structured consensus of representative members from various medical professions. It was compiled at the request of the guidelines commission of the DGGG.
Recommendations The guideline provides recommendations on the diagnosis, management, counseling, prophylaxis, and screening of fetal growth restriction.
Publication History
Received: 22 January 2025
Accepted: 03 February 2025
Article published online:
07 July 2025
© 2025. Thieme. All rights reserved.
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
-
References/Literatur
- 1 Unterscheider J, Daly S, Geary MP. et al. Definition and management of fetal growth restriction: a survey of contemporary attitudes. Eur J Obstet Gynecol Reprod Biol 2014; 174: 41-45
- 2 Lees CC, Stampalija T, Baschat A. et al. ISUOG Practice Guidelines: diagnosis and management of small-for-gestational-age fetus and fetal growth restriction. Ultrasound Obstet Gynecol 2020; 56: 298-312
- 3 Society for Maternal-Fetal Medicine (SMFM). Martins JG, Biggio JR. et al. Society for Maternal-Fetal Medicine Consult Series #52: Diagnosis and management of fetal growth restriction: (Replaces Clinical Guideline Number 3, April 2012). Am J Obstet Gynecol 2020; 223: B2-B17
- 4 American College of Obstetricians and Gynecologistsʼ Committee on Practice Bulletins–Obstetrics and the Society forMaternal-FetalMedicin. ACOG Practice Bulletin No. 204: Fetal Growth Restriction. Obstet Gynecol 2019; 133: e97-e109
- 5 Gordijn SJ, Beune IM, Thilaganathan B. et al. Consensus definition of fetal growth restriction: a Delphi procedure. Ultrasound Obstet Gynecol 2016; 48: 333-339
- 6 Parker SE, Werler MM. Epidemiology of ischemic placental disease: a focus on preterm gestations. Semin Perinatol 2014; 38: 133-138
- 7 Albu AR, Anca AF, Horhoianu VV. et al. Predictive factors for intrauterine growth restriction. J Med Life 2014; 7: 165-171
- 8 Mayer C, Joseph KS. Fetal growth: a review of terms, concepts and issues relevant to obstetrics. Ultrasound Obstet Gynecol 2013; 41: 136-145
- 9 Gaudineau A. [Prevalence, risk factors, maternal and fetal morbidity and mortality of intrauterine growth restriction and small-for-gestational age]. J Gynecol Obstet Biol Reprod (Paris) 2013; 42: 895-910
- 10 Jaddoe VW, Bakker R, Hofman A. et al. Moderate alcohol consumption during pregnancy and the risk of low birth weight and preterm birth. The generation R study. Ann Epidemiol 2007; 17: 834-840
- 11 Ananth CV, Peltier MR, Chavez MR. et al. Recurrence of ischemic placental disease. Obstet Gynecol 2007; 110: 128-133
- 12 Kramer MS, Platt R, Yang H. et al. Are all growth-restricted newborns created equal(ly)?. Pediatrics 1999; 103: 599-602
- 13 Gouin K, Murphy K, Shah PS. et al. Effects of cocaine use during pregnancy on low birthweight and preterm birth: systematic review and metaanalyses. Am J Obstet Gynecol 2011; 204: 340.e1-340.e12
- 14 Maulik D. Fetal growth restriction: the etiology. Clin Obstet Gynecol 2006; 49: 228-235
- 15 Odibo AO, Nelson D, Stamilio DM. et al. Advanced maternal age is an independent risk factor for intrauterine growth restriction. Am J Perinat 2006; 23: 325-328
- 16 Gardosi J, Francis A. Adverse pregnancy outcome and association with small for gestational age birthweight by customized and population-based percentiles. Am J Obstet Gynecol 2009; 201: 28.e1-28.e8
- 17 Blumenshine P, Egerter S, Barclay CJ. et al. Socioeconomic disparities in adverse birth outcomes: a systematic review. Am J Prev Med 2010; 39: 263-272
- 18 Kleijer ME, Dekker GA, Heard AR. Risk factors for intrauterine growth restriction in a socio-economically disadvantaged region. J Matern Fetal Neonatal Med 2005; 18: 23-30
- 19 Shah PS. Knowledge Synthesis Group on Determinants of LBWPT births. Parity and low birth weight and preterm birth: a systematic review and meta-analyses. Acta Obstet Gynecol Scand 2010; 89: 862-875
- 20 Yinon Y, Kingdom JCP, Odutayo A. et al. Vascular dysfunction in women with a history of preeclampsia and intrauterine growth restriction: insights into future vascular risk. Circulation 2010; 122: 1846-1853
- 21 Allen VM, Joseph K, Murphy KE. et al. The effect of hypertensive disorders in pregnancy on small for gestational age and stillbirth: a population based study. BMC Pregnancy Childbirth 2004; 4: 17
- 22 Fink JC, Schwartz SM, Benedetti TJ. et al. Increased risk of adverse maternal and infant outcomes among women with renal disease. Paediatr Perinat Epidemiol 1998; 12: 277-287
- 23 Howarth C, Gazis A, James D. Associations of Type 1 diabetes mellitus, maternal vascular disease and complications of pregnancy. Diabet Med 2007; 24: 1229-1234
- 24 Drenthen W, Pieper PG, Roos-Hesselink JW. et al. Outcome of pregnancy in women with congenital heart disease: a literature review. J Am Coll Cardiol 2007; 49: 2303-2311
- 25 Yasuda M, Takakuwa K, Tokunaga A. et al. Prospective studies of the association between anticardiolipin antibody and outcome of pregnancy. Obstet Gynecol 1995; 86: 555-559
- 26 Costa SL, Proctor L, Dodd JM. et al. Screening for placental insufficiency in high-risk pregnancies: is earlier better?. Placenta 2008; 29: 1034-1040
- 27 Laurini R, Laurin J, Marsal K. Placental histology and fetal blood flow in intrauterine growth retardation. Acta Obstet Gynecol Scand 1994; 73: 529-534
- 28 Salafia CM, Minior VK, Pezzullo JC. et al. Intrauterine growth restriction in infants of less than thirty-two weeksʼ gestation: associated placental pathologic features. Am J Obstet Gynecol 1995; 173: 1049-1057
- 29 Battarbee AN, Palatnik A, Ernst LM. et al. Association of Isolated Single Umbilical Artery With Small for Gestational Age and Preterm Birth. Obstet Gynecol 2015; 126: 760-764
- 30 Khoury MJ, Erickson JD, Cordero JF. et al. Congenital malformations and intrauterine growth retardation: a population study. Pediatrics 1988; 82: 83-90
- 31 Eydoux P, Choiset A, Le Porrier N. et al. Chromosomal prenatal diagnosis: study of 936 cases of intrauterine abnormalities after ultrasound assessment. Prenat Diagn 1989; 9: 255-269
- 32 Powers WF, Kiely JL. The risks confronting twins: a national perspective. Am J Obstet Gynecol 1994; 170: 456-461
- 33 Chauhan SP, Beydoun H, Chang E. et al. Prenatal detection of fetal growth restriction in newborns classified as small for gestational age: correlates and risk of neonatal morbidity. Am J Perinat 2014; 31: 187-194
- 34 Gardosi J, Madurasinghe V, Williams M. et al. Maternal and fetal risk factors for stillbirth: population based study. BMJ 2013; 346: f108
- 35 Rempen A. [Standards in ultrasound examination in early pregnancy. Recommendation of DEGUM Stage III of the German Society of Ultrasound in Medicine (Gynecology and Obstetrics Section) and ARGUS (Working Group of Ultrasound Diagnosis of DGGG). December 2000 revision]. Z Geburtshilfe Neonatol 2001; 205: 162-165
- 36 Standards zur Ultraschalluntersuchung in der Frühschwangerschaft. Leitlinie der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (S1-Level, AWMF-Register Nr. 015/032, August 2010).
- 37 Kehl S, Hösli I, Pecks U. et al. Induction of Labour. Guideline of the DGGG, OEGGG and SGGG (S2k, AWMF Registry No. 015-088, December 2020). Geburtshilfe Frauenheilkd 2021; 81: 870-895
- 38 AWMF 085-002 S2e LL Ersttrimester Diagnostik und Therapie @ 11–13 + 6 Schwangerschaftswochen. 2024. Accessed January 22, 2024 at: https://register.awmf.org/de/leitlinien/detail/085-002
- 39 Groom KM, Poppe KK, North RA. et al. Small-for-gestational-age infants classified by customized or population birthweight centiles: impact of gestational age at delivery. Am J Obstet Gynecol 2007; 197: 239.e1-239.e5
- 40 Figueras F, Figueras J, Meler E. et al. Customised birthweight standards accurately predict perinatal morbidity. Arch Dis Child Fetal Neonatal Ed 2007; 92: F277-F280
- 41 Unterscheider J, Geary MP, Daly S. et al. The customized fetal growth potential: a standard for Ireland. Eur J Obstet Gynecol Reprod Biol 2013; 166: 14-17
- 42 Gardosi J, Chang A, Kalyan B. et al. Customised antenatal growth charts. Lancet 1992; 339: 283-287
- 43 Evertson LR, Gauthier RJ, Schifrin BS. et al. Antepartum fetal heart rate testing. I. Evolution of the nonstress test. Am J Obstet Gynecol 1979; 133: 29-33
- 44 Richtlinien des Gemeinsamen Bundesausschusses über die ärztliche Betreuung während der Schwangerschaft und nach der Entbindung („Mutterschafts-Richtlinien“). Accessed September 20, 2017 at: https://www.g-ba.de/downloads/62-492-1223/Mu-RL_2016-04-21_iK-2016-07-20.pdf
- 45 Grivell RM, Wong L, Bhatia V. Regimens of fetal surveillance for impaired fetal growth. Cochrane Database Syst Rev 2012; (06) CD007113
- 46 Baschat AA, Galan HL, Bhide A. et al. Doppler and biophysical assessment in growth restricted fetuses: distribution of test results. Ultrasound Obstet Gynecol 2006; 27: 41-47
- 47 Turan S, Turan OM, Berg C. et al. Computerized fetal heart rate analysis, Doppler ultrasound and biophysical profile score in the prediction of acid-base status of growth-restricted fetuses. Ultrasound Obstet Gynecol 2007; 30: 750-756
- 48 Kaur S, Picconi JL, Chadha R. et al. Biophysical profile in the treatment of intrauterine growth-restricted fetuses who weigh < 1000 g. Am J Obstet Gynecol 2008; 199: 264.e1-264.e4
- 49 Lalor JG, Fawole B, Alfirevic Z. et al. Biophysical profile for fetal assessment in high risk pregnancies. Cochrane Database Syst Rev 2008; 2008 (01) CD000038
- 50 Lees CC, Marlow N, van Wassenaer-Leemhuis A. et al. 2 year neurodevelopmental and intermediate perinatal outcomes in infants with very preterm fetal growth restriction (TRUFFLE): a randomised trial. Lancet 2015; 385: 2162-2172
- 51 AWMF 015/083 (S3). Die vaginale Geburt am Termin. AWMF 2020. Accessed March 29, 2021 at: https://www.awmf.org/uploads/tx_szleitlinien/015-083k_S3_Vaginale-Geburt-am-Termin_2021-01_1.pdf
- 52 Wolf H, Gordijn SJ, Onland W. et al. Computerized fetal heart rate analysis in early preterm fetal growth restriction. Ultrasound Obstet Gynecol 2020; 56: 51-60
- 53 DeVore GR. The importance of the cerebroplacental ratio in the evaluation of fetal well-being in SGA and AGA fetuses. Am J Obstet Gynecol 2015; 213: 5-15
- 54 Hofmeyr GJ, Lawrie TA, Atallah AN. et al. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev 2014; (06) CD001059
- 55 Say L, Gülmezoglu AM, Hofmeyr GJ. Maternal nutrient supplementation for suspected impaired fetal growth. Cochrane Database Syst Rev 2003; (01) CD000148
- 56 Meher S, Duley L. Progesterone for preventing pre-eclampsia and its complications. Cochrane Database Syst Rev 2006; 2006 (04) CD006175
- 57 Say L, Gülmezoglu AM, Hofmeyr GJ. Maternal oxygen administration for suspected impaired fetal growth. Cochrane Database Syst Rev 2003; (01) CD000137
- 58 Nozaki AM, Francisco RP, Fonseca ES. et al. Fetal hemodynamic changes following maternal betamethasone administration in pregnancies with fetal growth restriction and absent end-diastolic flow in the umbilical artery. Acta Obstet Gynecol Scand 2009; 88: 350-354
- 59 Newnham JP, Godfrey M, Walters BJ. et al. Low dose aspirin for the treatment of fetal growth restriction: a randomized controlled trial. Aust N Z J Obstet Gynaecol 1995; 35: 370-374
- 60 Lausman A, Kingdom J. MATERNAL FETAL MEDICINE COMMITTEE. Intrauterine growth restriction: screening, diagnosis, and management. J Obstet Gynaecol Can 2013; 35: 741-748
- 61 von Dadelszen P, Dwinnell S, Magee LA. et al. Sildenafil citrate therapy for severe early-onset intrauterine growth restriction. BJOG 2011; 118: 624-628
- 62 Gülmezoglu AM, Hofmeyr GJ. Betamimetics for suspected impaired fetal growth. Cochrane Database Syst Rev 2001; (04) CD000036
- 63 Abalos E, Duley L, Steyn DW. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database Syst Rev 2014; (02) CD002252
- 64 Schleussner E, Lehmann T, Kahler C. et al. Impact of the nitric oxide-donor pentaerythrityl-tetranitrate on perinatal outcome in risk pregnancies: a prospective, randomized, double-blinded trial. J Perinat Med 2014; 42: 507-514
- 65 Smith GC, Pell JP, Walsh D. Pregnancy complications and maternal risk of ischaemic heart disease: a retrospective cohort study of 129,290 births. Lancet 2001; 357: 2002-2006
- 66 Gordon A, Raynes-Greenow C, McGeechan K. et al. Stillbirth risk in a second pregnancy. Obstet Gynecol 2012; 119: 509-517
- 67 Surkan PJ, Stephansson O, Dickman PW. et al. Previous preterm and small-for-gestational-age births and the subsequent risk of stillbirth. N Engl J Med 2004; 350: 777-785
- 68 Evers AC, van Rijn BB, van Rossum MM. et al. Subsequent pregnancy outcome after first pregnancy with normotensive early-onset intrauterine growth restriction at < 34 weeks of gestation. Hypertens Pregnancy 2011; 30: 37-44
- 69 Bakketeig LS, Bjerkedal T, Hoffman HJ. Small-for-gestational age births in successive pregnancy outcomes: results from a longitudinal study of births in Norway. Early Hum Dev 1986; 14: 187-200
- 70 Voskamp BJ, Kazemier BM, Ravelli AC. et al. Recurrence of small-for-gestational-age pregnancy: analysis of first and subsequent singleton pregnancies in The Netherlands. Am J Obstet Gynecol 2013; 208: 374.e1-374.e6
- 71 Blue NR, Page JM, Silver RM. Recurrence Risk of Fetal Growth Restriction: Management of Subsequent Pregnancies. Obstet Gynecol Clin North Am 2021; 48: 419-436
- 72 Lees C, Valensise H, Black R. et al. The efficacy and fetal-maternal cardiovascular effects of transdermal glyceryl trinitrate in the prophylaxis of pre-eclampsia and its complications: a randomized double-blind placebo-controlled trial. Ultrasound Obstet Gynecol 1998; 12: 334-338
- 73 Groten T, Lehmann T, Städtler M. et al. Effect of pentaerythritol tetranitrate (PETN) on the development of fetal growth restriction in pregnancies with impaired uteroplacental perfusion at midgestation-a randomized trial. Am J Obstet Gynecol 2023; 228: 84.e1-84.e12
- 74 Groten T, Lehmann T, Städtler M. et al. Pentaerythrityl tetranitrate improves the outcome of children born to mothers with compromised uterine perfusion-12-months follow-up and safety data of the double-blind randomized PETN trial. Am J Obstet Gynecol MFM 2024; 6: 101332
- 75 Lindqvist PG, Molin J. Does antenatal identification of small-for-gestational age fetuses significantly improve their outcome?. Ultrasound Obstet Gynecol 2005; 25: 258-264
- 76 Karagiannis G, Akolekar R, Sarquis R. et al. Prediction of small-for-gestation neonates from biophysical and biochemical markers at 11–13 weeks. Fetal Diagn Ther 2011; 29: 148-154