ANALYTICAL REVIEW OF THE NATIONAL AND INTERNATIONAL CLINICAL GUIDELINES FOR THE MANAGEMENT OF PREGNANCIES COMPLICATED BY FETAL GROWTH RESTRICTION

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. © A group of authors, 2024.