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The investigation and management of the small–for–gestational–age fetus

The purpose of this guideline is to provide advice that is based on the best evidence where available in order to guide clinicians, regarding the investigation and management of the small–for–gestational age (SGA) fetus. The guideline reviews the risk factors for a SGA fetus and provides recommendations regarding screening, diagnosis and management, including fetal monitoring and delivery. | The Investigation and Management of the Small–for–Gestational–Age Fetus Green–top Guideline No. 31 2nd Edition | February 2013 | Minor revisions – January 2014 The Investigation and Management of the Small–for–Gestational–Age Fetus This is the second edition of this guideline. It replaces the first edition which was published in November 2002 under the same title. Executive Summary of Recommendations Risk factors for a SGA fetus/neonate All women should be assessed at booking for risk factors for a SGA fetus/neonate to identify those who require increased surveillance. P Women who have a major risk factor (Odds Ratio [OR] > 2.0) should be referred for serial ultrasound measurement of fetal size and assessment of wellbeing with umbilical artery Doppler from 26–28 weeks of pregnancy (Appendix 1). B Women who have three or more minor risk factors should be referred for uterine artery Doppler at 20–24 weeks of gestation (Appendix 1). P Second trimester DS markers have limited predictive accuracy for delivery of a SGA neonate. B A low level ( 95th centile) and/or notching should be referred for serial ultrasound measurement of fetal size and assessment of wellbeing with umbilical artery Doppler commencing at 26–28 weeks of pregnancy. P Women with a normal uterine artery Doppler do not require serial measurement of fetal size and serial assessment of wellbeing with umbilical artery Doppler unless they develop specific pregnancy complications, for example antepartum haemorrhage or hypertension. However, they should be offered a scan for fetal size and umbilical artery Doppler during the third trimester. P Serial ultrasound measurement of fetal size and assessment of wellbeing with umbilical artery Doppler should be offered in cases of fetal echogenic bowel. C Abdominal palpation has limited accuracy for the prediction of a SGA neonate and thus should not be routinely performed in this context. C Serial measurement of symphysis fundal height (SFH) is .