Fetal growth restriction

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About the course

This course is part of the RCOG Core Knowledge series.

Small-for-gestational age (SGA) refers to a fetus with a birth weight less than the 10th centile. SGA birth is defined as an estimated fetal weight (EFW) or abdominal circumference (AC) less than the 10th centile and severe SGA as an EFW or AC less than the 3rd centile. 50–70% of SGA fetuses are constitutionally small, with fetal growth appropriate for maternal size and other important factors such as ethnicity. The remaining 30-40% are considered to have fetal growth restriction.

Fetal growth restriction (FGR) refers to failure of the fetus to achieve its predetermined growth potential for various reasons.

Low birth weight (LBW) refers to an infant with a birth weight <2500 g. FGR greatly contributes to perinatal mortality and short- and long-term morbidity. There is a 3–10 fold increase in perinatal mortality in pregnancies complicated by this FGR. Therefore, identification and differentiation of potentially growth restricted fetuses (small and unhealthy) from the 'small and healthy' fetus presents a massive challenge in obstetric practice.

Course overview Authors Audience Capabilities in Practice (CiPs) Related guidelines

When you have completed this course, you will be able to:

  • define what is meant by the terms FGR and small for gestational age, and the differences between symmetrical FGR and asymmetrical FGR
  • understand its aetiology
  • understand the adverse outcomes associated with the condition
  • understand how to screen for and diagnose the condition
  • understand the principles of management of pregnancies recognised to be complicated by the condition.
Dr Helen Russell MRCOG (2021, 2022)
This course is intended to help clinicians gain core knowledge for O&G training and the MRCOG examinations. It can also be used by O&G consultants to refresh their knowledge of the area or for teaching.

The content of this course relates to the following Capabilities in Practice (CiPs) and key skills:

CiP 1: Clinical skills and patient care
History taking, clinical examination and diagnosis
Facilitates discussions
Provides treatment

CiP 2: Working in health organisations
Adheres to legal, professional requirements
Understands ethical principles
Working in a digital environment

CiP 3: Leadership
Demonstrates insight
Effective use of resources

CiP 5: Human factors
Maintains situational awareness
Demonstrates insight into decision making
Team working
Understands systems and organisational factors

CiP 6: Developing self & others
Commits to continued learning
Develops people

CiP 8: Educator
Effective teaching

CiP 10: Emergency obstetrics
Manages concerns about fetal wellbeing

CiP 12: Non-emergency obstetrics
Manages conditions arising in pregnancy
Manages fetal concerns
Supports antenatal decision making

Further details about each CiP can be found within the O&G Core Curriculum 2024 Definitive Document, available here .

National Institute of Health and Care Excellence. Antenatal Care. Clinical Guideline 201. London: NICE; 2021.

Royal College of Obstetricians and Gynaecologists. The Investigation and Management of the Small-for-Gestational-Age Fetus. Green-top Guideline 31. London: RCOG; 2013.

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