{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T04:20:34Z","timestamp":1790914834326,"version":"4.1.0"},"reference-count":51,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,6,30]],"date-time":"2023-06-30T00:00:00Z","timestamp":1688083200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>There is limited prospective evidence to guide the management of late\u2010onset fetal growth restriction (FGR) and its differentiation from small\u2010for\u2010gestational age. The aim of this study was to assess prospectively a novel protocol in which ultrasound criteria were used to classify women with suspected late FGR into two groups: those at low risk, who were managed expectantly until the anticipated date of delivery, and those at high risk, who were delivered soon after 37\u2009weeks of gestation. We also compared the outcome of this prospective cohort with that of a historical cohort of women presenting similarly with suspected late FGR, in order to evaluate the impact of the new protocol.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a prospective study of women with a non\u2010anomalous singleton pregnancy at \u2265\u200932\u2009weeks' gestation attending a tertiary hospital in London, UK, between February 2018 and September 2019, with estimated fetal weight (EFW)\u2009\u2264\u200910<jats:sup>th<\/jats:sup> centile, or EFW\u2009&gt;\u200910<jats:sup>th<\/jats:sup> centile in addition to a decrease in fetal abdominal circumference of \u2265\u200950 centiles compared with a previous scan, umbilical artery Doppler pulsatility index &gt;\u200995<jats:sup>th<\/jats:sup> centile or cerebroplacental ratio &lt;\u20095<jats:sup>th<\/jats:sup> centile. Women were classified as low  or high risk based on ultrasound and Doppler criteria. Women in the low\u2010risk group were delivered by 41\u2009weeks of gestation, unless they subsequently met high\u2010risk criteria, whereas women in the high\u2010risk group (EFW &lt;\u20093<jats:sup>rd<\/jats:sup> centile, umbilical artery Doppler pulsatility index &gt;\u200995<jats:sup>th<\/jats:sup> centile or EFW between 3<jats:sup>rd<\/jats:sup> and 10<jats:sup>th<\/jats:sup> centiles (inclusive) with abdominal circumference drop or abnormal Dopplers) were delivered at or soon after 37\u2009weeks. The primary outcome was adverse neonatal outcome and included hypothermia, hypoglycemia, neonatal unit admission, jaundice requiring treatment, suspected infection, feeding difficulties, 1\u2010min Apgar score &lt;\u20097, hospital readmission and any severe adverse neonatal outcome (perinatal death, resuscitation using inotropes or mechanical ventilation, 5\u2010min Apgar score &lt;\u20097, metabolic acidosis, sepsis, and cerebral, cardiac or respiratory morbidity). Secondary outcomes were adverse maternal outcome (operative delivery for abnormal fetal heart rate) and severe adverse neonatal outcome. Women managed according to the new protocol were compared with a historical cohort of 323 women delivered prior to the implementation of the new protocol, for whom management was guided by individual clinician expertise.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Over 18\u2009months, 321 women were recruited to the prospective cohort, of whom 156 were classified as low risk and 165 were high risk. Adverse neonatal outcome was significantly less common in the low\u2010risk compared with the high\u2010risk group (45% <jats:italic>vs<\/jats:italic> 58%; adjusted odds ratio (aOR), 0.6 (95%\u2009CI, 0.4\u20130.9); <jats:italic>P<\/jats:italic>\u2009=\u20090.022). There was no significant difference in the rate of adverse maternal outcome (18% <jats:italic>vs<\/jats:italic> 24%; aOR, 0.7 (95%\u2009CI, 0.4\u20131.2); <jats:italic>P<\/jats:italic>\u2009=\u20090.142) or severe adverse neonatal outcome (3.8% <jats:italic>vs<\/jats:italic> 8.5%; aOR, 0.5 (95%\u2009CI, 0.2\u20131.3); <jats:italic>P<\/jats:italic>\u2009=\u20090.153) between the low\u2010 and high\u2010risk groups. Compared with women in the historical cohort classified retrospectively as low risk, low\u2010risk women managed under the new protocol had a lower rate of adverse neonatal outcome (45% <jats:italic>vs<\/jats:italic> 58%; aOR, 0.6 (95%\u2009CI, 0.4\u20130.9); <jats:italic>P<\/jats:italic>\u2009=\u20090.026).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Appropriate risk stratification to guide management of late FGR was associated with a reduced rate of adverse neonatal outcome in low\u2010risk pregnancies. In clinical practice, a policy of expectantly managing women with a low\u2010risk late\u2010onset FGR pregnancy at term could improve neonatal and long\u2010term development. Randomized controlled trials are needed to assess the effect of an evidence\u2010based conservative management protocol for late FGR on perinatal morbidity and mortality and long\u2010term neurodevelopment. \u00a9 2023 The Authors. Ultrasound in Obstetrics &amp; Gynecology published by John Wiley &amp; Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.26190","type":"journal-article","created":{"date-parts":[[2023,3,3]],"date-time":"2023-03-03T04:25:01Z","timestamp":1677817501000},"page":"106-114","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Management of late\u2010onset fetal growth restriction: pragmatic approach"],"prefix":"10.1002","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4495-8072","authenticated-orcid":false,"given":"R.","family":"Peasley","sequence":"first","affiliation":[{"name":"Elizabeth Garrett Anderson Institute for Women's Health University College London  London UK"},{"name":"Fetal Medicine Unit, Elizabeth Garrett Anderson Wing University College London Hospitals NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. 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