# Fetal growth restriction - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Fetal Growth Restriction - StatPearls - NCBI Bookshelf (NBK562268) - https://www.ncbi.nlm.nih.gov/books/NBK562268/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class WD71.03 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care ## Treatment metadata - No drug therapy in primary care (Referral & Advice) ## Complete treatment card ```text FETAL GROWTH RESTRICTION Sources: Fetal Growth Restriction - StatPearls - NCBI Bookshelf (NBK562268) - https://www.ncbi.nlm.nih.gov/books/NBK562268/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class WD71.03 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care Review status: REVIEWED against the source listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (2) - A prior pregnancy with preeclampsia, smoking or substance use, a multiple pregnancy, low body weight, or conception by assisted methods raises the risk - Chronic maternal illness such as long-standing high blood pressure, kidney disease, or lupus, and being at either extreme of maternal age, adds risk [hypertension] SIGNS - what you find (5) - Fundal height should roughly match gestational age in weeks; at 32 to 34 weeks this is about 65 to 85 percent sensitive and 96 percent specific, though maternal obesity or fibroids reduce its accuracy [obesity] - An affected newborn weighs below the tenth percentile and looks wasted, with little muscle bulk or fat under the skin - A Ponderal Index below the tenth percentile signals fetal malnutrition, particularly in the asymmetric form of this condition - Liver enlargement, hearing loss, chorioretinitis, and blueberry-muffin skin spots suggest a congenital CMV infection as the cause [hearing loss] - Low-set ears, a cleft palate, an overlapping-finger clenched fist, and rocker-bottom feet suggest trisomy 18 [dysmorphic features] TESTS (7) - Ultrasound to check fetal growth is recommended once fundal height is off by more than 3 cm from the weeks of gestation - An estimated fetal weight below the tenth percentile should trigger further work-up for growth restriction - Head-to-abdomen and femur-to-head circumference ratios on ultrasound help tell symmetric from asymmetric growth restriction apart - When estimated weight or abdominal circumference falls below the tenth percentile, amniotic fluid and umbilical artery Doppler studies are recommended next - Growth ultrasounds are usually repeated every 3 to 4 weeks to track the fetal growth curve over time - Umbilical artery Doppler resistance rises as placental insufficiency worsens, eventually reaching absent or reversed end-diastolic flow as blood is shunted to the fetal brain - When umbilical artery Doppler shows flow that is absent or reversed at end-diastole, the risk of death around birth is higher IF NOT THIS - what else fits (3) - An inaccurately dated pregnancy can look like growth restriction, so confirming gestational age correctly is essential to tell them apart - Oligohydramnios and a genetically small fetus are also on the differential - A constitutionally small but healthy fetus is told apart from true growth restriction by a slowing rate of abdominal-circumference growth on serial scans plus Doppler and antenatal monitoring Source StatPearls "Fetal Growth Restriction" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult A suspected small-for-dates fetus found on clinical or ultrasound assessment; the GP recognises and refers to obstetrics for growth monitoring and delivery timing. - Refer, with advice Peds Adult-only condition - paediatric section not applicable Source No dose - referral pathway, no medicine given in primary care Why A suspected small-for-dates fetus found on clinical or ultrasound assessment; the GP recognises and refers to obstetrics for growth monitoring and delivery timing. Caution RED FLAG - Maternal hypertension or preeclampsia symptoms: assess urgently and refer. RED FLAG - Oligohydramnios (amniotic fluid index < 5 cm or single deepest pocket < 2 cm): assess urgently and refer. Severe growth restriction with reduced fetal movements or abnormal blood flow studies needs urgent obstetric referral. No medicine is prescribed for this in primary care - this entry is for recognition and referral. 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