Analytical review of the national and international clinical guidelines for the management of pregnancies complicated by fetal growth restriction

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Fetal growth restriction (FGR) affects about 10% of pregnancies and it is a leading cause of stillbirth, neonatal mortality and morbidity. In addition to immediate complications, it has metabolic imprinting and affects perinatal programming.

Among the great obstetrical syndromes, FGR occupies a special place, primarily due to the lack of clinical manifestations. In this regard, modern obstetric tactics are based solely on functional methods of diagnostics of the fetal condition. The existing clinical guidelines and protocols on this issue make it much easier for clinicians to decide on an emergency delivery. At the same time, clinical situations where a balance must be achieved between prolongation of pregnancy and the risk of antenatal fetal death require close monitoring of specific anatomical zones of fetal-placental circulation, depending on the gestational age. This review presents the analysis of the national (Russian Society of Obstetricians and Gynecologists) and international (FIGO, ISUOG, SMFM, ACOG) clinical guidelines and protocols in order to form a consensus approach and, if necessary, to identify areas for further research to standardize obstetric management of pregnant women with FGR.

Conclusion: Future research should focus on determining differentiated functional diagnostic test scores based on estimated fetal weight, gestational age, patient condition, and neonatal development. Such a practical approach based on randomized trials and its implementation in clinical guidelines will reduce perinatal morbidity and mortality, as well as improve long-term outcomes in late FGR.

作者简介

Zulfiya Khodzhaeva

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

编辑信件的主要联系方式.
Email: z_khodzhaeva@oparina4.ru
ORCID iD: 0000-0001-8159-3714

Dr. Med. Sci., Professor, Deputy Director, Institute of Obstetrics

俄罗斯联邦, Moscow

Elizaveta Stolyarova

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: ev_stolyarova@oparina4.ru
ORCID iD: 0009-0001-2049-3119

PhD Student, 1st Obstetric Department of Pregnancy Pathology

俄罗斯联邦, Moscow

Alexey Kholin

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: a_kholin@oparina4.ru
ORCID iD: 0000-0002-4068-9805

PhD, Head of the Department of Telemedicine

俄罗斯联邦, Moscow

Alexander Gus

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; Patrice Lumumba Peoples’ Friendship University of Russia

Email: a_gus@oparina4.ru
ORCID iD: 0000-0003-1377-3128

Dr. Med. Sci., Chief Researcher at the Department of Ultrasound and Functional Diagnostics; Head of the Department of Ultrasound Diagnostics, Medical Institute

俄罗斯联邦, Moscow; Moscow

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