At booking, your midwife may carry out a risk assessment for foetal growth restriction (FGR). This considers both major and minor risk factors for FGR and will form the basis for foetal growth monitoring in pregnancy.
Major risk factors
Maternal demographics
– Maternal age ≥ 40 years (nulliparous)
– Continued smoking ≥ 16weeks’ gestation (> 10 per day)
– Recreational drug use
Previous pregnancy history
– *Previous FGR pregnancy*
– *Previous hypertensive disease of pregnancy*
– *Previous stillbirth
Maternal medical history
– *Chronic hypertension*
– *Diabetes with vascular disease*
– *Renal impairment*
– *Antiphospholipid syndrome*
Current pregnancy risk
– Heavy bleeding < 20 weeks’ gestation
– Pre-eclampsia or gestational hypertension
– Antepartum haemorrhage or placental abruption
The risk factors with stars around them are indicative of the risk of early-onset (before 24 weeks) growth restriction
Minor risk factors
Maternal demographics
– Nulliparity
– Maternal age ≥ 40 years (multiparous)
– Smoking 1 to 10 cigarettes per day
Previous pregnancy history
– Short (< 6 months) or long (> 60 months) interpregnancy interval
Maternal medical history
– Conception via assisted reproductive technology
– BMI > 30 or < 18.5
Current pregnancy risk
– Placenta praevia
– Low gestational weight gain
Recommendations
– low risk: no major risk factors and <3 minor risk factors: serial fundal height measurements from 26-28 weeks, plotted on customised growth chart
– increased risk: 1 or more major risk factors: low-dose aspirin (100mg at night) from 12-16wk through to 36wk if indicated; monthly ultrasound assessment of growth starting at 28-30 weeks
– increased risk of early-onset FGR: 1 or more major risk factors for early-onset FGR (indicated by stars): low-dose aspirin from 12-16wk through to 36wk; uterine artery doppler with anatomy scan; monthly ultrasound assessment of growth starting at 24-26 weeks
– increased risk: no major and 3 or more minor risk factors: two ultrasound assessments of growth, at 30-32 and 36-38 weeks.
– unreliable fundal height measurements – due to BMI more than 35/large or multiple fibroids/polyhydramnios: two ultrasound assessments of growth, at 30-32 and 36-38 weeks