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ISUOG Practice Guidelines: ultrasound assessment of fetal biometry and growth

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Salomon, L.J., Alfirevic, Z., Da Silva Costa, F., Deter, R.L., Figueras, F., Ghi, T., Glanc, P., Khalil, A. +7 more·2019·Ultrasound in Obstetrics & Gynecology
DOI 10.1002/uog.20272
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Abstract

INTRODUCTION: These Guidelines aim to describe appropriate assessment of fetal biometry and diagnosis of fetal growth disorders. These disorders consist mainly of fetal growth restriction (FGR), also referred to as intrauterine growth restriction (IUGR) and often associated with small‐for‐gestational age (SGA), and large‐for‐gestational age (LGA), which may lead to fetal macrosomia; both have been associated with a variety of adverse maternal and perinatal outcomes. Screening for, and adequate management of, fetal growth abnormalities are essential components of antenatal care, and fetal ultrasound plays a key role in assessment of these conditions. The fetal biometric parameters measured most commonly are biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur diaphysis length (FL). These biometric measurements can be used to estimate fetal weight (EFW) using various different formulae 1 . It is important to differentiate between the concept of fetal size at a given timepoint and fetal growth, the latter being a dynamic process, the assessment of which requires at least two ultrasound scans separated in time. Maternal history and symptoms, amniotic fluid assessment and Doppler velocimetry can provide additional information that may be used to identify fetuses at risk of adverse pregnancy outcome. Accurate estimation of gestational age is a prerequisite for determining whether fetal size is appropriate‐for‐gestational age (AGA). Except for pregnancies arising from assisted reproductive technology, the date of conception cannot be determined precisely. Clinically, most pregnancies are dated by the last menstrual period, though this may sometimes be uncertain or unreliable. Therefore, dating pregnancies by early ultrasound examination at 8–14 weeks, based on measurement of the fetal crown–rump length (CRL), appears to be the most reliable method to establish gestational age. Once the CRL exceeds 84 mm, HC should be used for pregnancy dating 2–4 . HC, with or without FL, can be used for estimation of gestational age from the mid‐trimester if a first‐trimester scan is not available and the menstrual history is unreliable. When the expected delivery date has been established by an accurate early scan, subsequent scans should not be used to recalculate the gestational age 1 . Serial scans can be used to determine if interval growth has been normal. In these Guidelines, we assume that the gestational age is known and has been determined as described above, the pregnancy is singleton and the fetal anatomy is normal. Details of the grades of recommendation used in these Guidelines are given in Appendix 1. Reporting of levels of evidence is not applicable to these Guidelines.

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  • To diagnose late-onset fetal growth restriction prenatally, Doppler assessment of the umbilical and cerebral blood flow is necessary, yet it is not a routine practice.

    “To diagnose late‐onset fetal growth restriction prenatally, Doppler assessment of the umbilical and cerebral blood flow is necessary, yet it is not a routine practice.”

    From Neonatal outcome of infants with umbilical cord arterial <scp>pH</scp> less than 7 (2023) · cites this paper as [27]

    The ‘Recommendations for the generation of growth standards’ section includes fetal Doppler findings among parameters used to diagnose FGR, but also permits AC or EFW below the 3rd centile as a sole criterion and identifies serial growth measurements as another option. The screening section says additional third-trimester scans depend on local guidelines and risk factors; it does not establish that umbilical and cerebral Doppler assessment is necessary for every late-onset diagnosis or that it is not routine practice. (LLM, conf=0.87)

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  1. Salomon, L. J., Alfirevic, Z., Da Silva Costa, F., Deter, R. L., Figueras, F., Ghi, T., Glanc, P., Khalil, A., Lee, W., Napolitano, R., Papageorghiou, A., Sotiriadis, A., Stirnemann, J., Toi, A. & Yeo, G. (2019). ISUOG Practice Guidelines: ultrasound assessment of fetal biometry and growth.. Ultrasound Obstet Gynecol, 53 (6), pp.715-723. https://doi.org/10.1002/uog.20272. Persistent Link: http://hdl.handle.net/11343/285896

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Authors
Salomon, L. J., Alfirevic, Z., Da Silva Costa, F., Deter, R. L., Figueras, F., Ghi, T., Glanc, P., Khalil, A., Lee, W., Napolitano, R., Papageorghiou, A., Sotiriadis, A., Stirnemann, J., Toi, A., & Yeo, G.
Affiliations
  • Hôpital Necker-Enfants Malades (FR)
  • Department of Women's and Children's Health University of Liverpool Liverpool UK
  • Department of Gynecology and Obstetrics Ribeirao Preto Medical School, University of Sao Paulo Ribeirao Preto, Sao Paulo Brazil
  • Baylor College of Medicine (US)
  • Hospital Clínic de Barcelona (ES)
  • University of Parma (IT)
  • University of Toronto (CA)
  • St George's, University of London (GB)
  • University of Oxford (GB)
  • St George’s University Hospitals NHS Foundation Trust (GB)
  • Aristotle University of Thessaloniki (GR)
  • Mount Sinai Hospital (CA)
  • KK Women's and Children's Hospital (SG)
Corresponding author
Salomon, L.J.
ORCID
Venue
Ultrasound in Obstetrics & Gynecology
Publisher
Wiley
Published
2019-06
Volume
53
Issue
6
Pages
715-723
ISSN
  • 0960-7692 (ISSN-L)
  • 1469-0705
DOI
10.1002/uog.20272
OpenAlex
W2948481417
Cited by
704
References
63
Citations by year
2026: 103 · 2025: 124 · 2024: 108 · 2023: 103 · 2022: 103 · 2021: 96 · 2020: 57 · 2019: 9
FWCI
72.03
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 5 d)
Locations
  • Ultrasound in Obstetrics and Gynecology (publishedVersion)
  • PubMed (publishedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion)
  • Griffith Research Online (submittedVersion)
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Screening and Diagnostics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
Keywords
fetal biometry, fetal growth restriction, small for gestational age, large for gestational age, macrosomia, fetal growth disorders, gestational age estimation, crown-rump length, biparietal diameter, head circumference, abdominal circumference, femur length, estimated fetal weight, prenatal ultrasound, interval growth, Doppler velocimetry
MeSH terms
Biometry, Female, Fetal Growth Retardation, Humans, Obstetrics, Pregnancy, Societies, Medical, Ultrasonography, Prenatal, Crown-Rump Length

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