Fetal growth

Abstract

Fetal growth is a complex and highly orchestrated process. Monitoring fetal growth is one of the cornerstones of the evaluation of fetal well-being. This chapter explores the global epidemiology of poor fetal growth, the controversies around the definition of the condition, and the scientific validity of the multitude of growth charts and approaches to fetal growth currently in use around the world. In 2014, the accepted approaches to fetal growth were challenged by the findings of the international INTERGROWTH-21st Project. This major international project demonstrated that the growth of babies in utero and the size of babies around the world are remarkably similar if maternal environmental, social, and medical conditions are relatively optimal. From this study, the first standards for fetal and newborn growth have been produced. The management of babies detected to be large for gestational age (LGA) also remains controversial and a clinical challenge. With increasing rates of maternal obesity and gestational diabetes, a growing proportion of babies are born LGA or detected to be LGA in utero. Other than the treatment for gestational diabetes, the evidence for effective interventions to prevent the development of LGA during pregnancy is limited. Key issues regarding the management of LGA include the most appropriate timing and mode of delivery to prevent shoulder dystocia and birth trauma.