Cited by 719Pregnancy and preeclampsia studiesPrenatal Screening and DiagnosticsBirth, Development, and Health

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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., Lee, W., Napolitano, R., Papageorghiou, A., Sotiriadis, A., Stirnemann, J., Toi, A., Yeo, G.·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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Papageorghiou A with input from Salomon L Ioannou C Sarris I and the INTERGROWTH‐21st Anthropometry team. Intergrowth‐21st. International Fetal and Newborn Growth Standards for the 21st Century. The International Fetal and Newborn Growth Consortium. Ultrasound Operations Manual. September 2009. University of Oxford Oxford.https://intergrowth21.tghn.org/site_media/media/articles/US_Manual_FINAL.pdf

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Additional file 6 of Which chart and which cut-point: deciding on the INTERGROWTH, World Health Organization, or Hadlock fetal growth chart
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Additional file 7 of Which chart and which cut-point: deciding on the INTERGROWTH, World Health Organization, or Hadlock fetal growth chart
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Additional file 7 of Evaluation of antenatal point-of-care ultrasound training workshops for rural/remote healthcare clinicians: a prospective single cohort study
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Additional file 10 of Evaluation of antenatal point-of-care ultrasound training workshops for rural/remote healthcare clinicians: a prospective single cohort study
Bidner, A., Bezak, E., & Parange, N. (2024) · Figshare · doi:10.6084/m9.figshare.26558519
Additional file 2 of Which chart and which cut-point: deciding on the INTERGROWTH, World Health Organization, or Hadlock fetal growth chart
Liauw, J., Mayer, C., Albert, A., Fernandez, A., & Hutcheon, J. A. (2022) · Figshare · doi:10.6084/m9.figshare.18132148
Additional file 5 of Intrauterine growth pattern in Butajira HDSS, Southern Ethiopia: BUNMAP pregnancy cohort
Mengistu, Y. G., Hailemariam, D., Roro, M. A., Endris, B. S., Tesfamariam, K., & Gebreyesus, S. H. (2024) · Figshare · doi:10.6084/m9.figshare.26612567
Additional file 1 of Correlation between crown-rump length in the first trimester of pregnancy and neonatal outcomes
Xu, Y., Ni, M., Zhang, Q., Zhao, J., Tang, Z., & Liu, Z. (2022) · Figshare · doi:10.6084/m9.figshare.20219690
Additional file 4 of Evaluation of antenatal point-of-care ultrasound training workshops for rural/remote healthcare clinicians: a prospective single cohort study
Bidner, A., Bezak, E., & Parange, N. (2024) · Figshare · doi:10.6084/m9.figshare.26558501
Additional file 1 of Fetal growth velocity references from a Chinese population–based fetal growth study
Wu, T., Gong, X., Zhao, Y., Zhang, L., You, Y., Wei, H., Zuo, X., Zhou, Y., Xing, X., Meng, Z., et al. (2021) · Figshare · doi:10.6084/m9.figshare.16779715
Additional file 6 of Evaluation of antenatal point-of-care ultrasound training workshops for rural/remote healthcare clinicians: a prospective single cohort study
Bidner, A., Bezak, E., & Parange, N. (2024) · Figshare · doi:10.6084/m9.figshare.26558507
Additional file 4 of Arterial health during early childhood following abnormal fetal growth
Olander, R. F. W., Sundholm, J. K. M., Suonsyrjä, S., & Sarkola, T. (2022) · Figshare · doi:10.6084/m9.figshare.18461955
Additional file 7 of Intrauterine growth pattern in Butajira HDSS, Southern Ethiopia: BUNMAP pregnancy cohort
Mengistu, Y. G., Hailemariam, D., Roro, M. A., Endris, B. S., Tesfamariam, K., & Gebreyesus, S. H. (2024) · Figshare · doi:10.6084/m9.figshare.26612573
Additional file 10 of Which chart and which cut-point: deciding on the INTERGROWTH, World Health Organization, or Hadlock fetal growth chart
Liauw, J., Mayer, C., Albert, A., Fernandez, A., & Hutcheon, J. A. (2022) · Figshare · doi:10.6084/m9.figshare.18132142
Additional file 3 of Evaluation of antenatal point-of-care ultrasound training workshops for rural/remote healthcare clinicians: a prospective single cohort study
Bidner, A., Bezak, E., & Parange, N. (2024) · Figshare · doi:10.6084/m9.figshare.26558498
Additional file 1 of Intrauterine growth pattern in Butajira HDSS, Southern Ethiopia: BUNMAP pregnancy cohort
Mengistu, Y. G., Hailemariam, D., Roro, M. A., Endris, B. S., Tesfamariam, K., & Gebreyesus, S. H. (2024) · Figshare · doi:10.6084/m9.figshare.26612555
Additional file 1 of Parity and the risks of adverse birth outcomes: a retrospective study among Chinese
Lin, L., Lu, C., Chen, W., Li, C., & Guo, V. Y. (2021) · Figshare · doi:10.6084/m9.figshare.14329321
Additional file 1 of Which chart and which cut-point: deciding on the INTERGROWTH, World Health Organization, or Hadlock fetal growth chart
Liauw, J., Mayer, C., Albert, A., Fernandez, A., & Hutcheon, J. A. (2022) · Figshare · doi:10.6084/m9.figshare.18132145
Additional file 4 of Parity and the risks of adverse birth outcomes: a retrospective study among Chinese
Lin, L., Lu, C., Chen, W., Li, C., & Guo, V. Y. (2021) · Figshare · doi:10.6084/m9.figshare.14329330

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: Salomon, L.J.
Deter, R.L.
Figueras, F.
Ghi, T.
Glanc, P.
Khalil, A.
Napolitano, R.
Papageorghiou, A.
Sotiriadis, A.
Stirnemann, J.
Toi, A.
Yeo, G.
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: bronze
doi.org
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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