Abstract

There is international consensus that pregnancies affected by suboptimal fetal growth pose a daily challenge for obstetricians, and that guidance documents should be available to inform best practice of these pregnancies. Clinical practice guidelines should be evidence based and aimed at standardising and improving care for defined populations, including pregnancy. Poor fetal growth complicates around 10% of pregnancies, but there are uncertainties as to how best to look after and manage these pregnancies. This review aimed to compare and contrast recommendations published in several international guidelines from professional organisations in Obstetrics and Gynaecology, including the US, UK, Canada and Ireland. Guidelines used different terminology and had different approaches to screening and diagnosis of poor fetal growth. There were also different opinions on which management strategy was best and recommendations on timing of birth also varied. This review highlights the disparities that exist between various national protocols on the management of fetal growth problems in pregnancy, despite access to the same published literature. There are some important and outstanding questions in this field needing urgent resolution with respect to terminology, definition, surveillance, and timing of birth, and this paper calls for an urgent international consensus on some of these core issues.