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Obstetrics and Gynegology2024№8
Analytical review of the national...

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

DOI
https://dx.doi.org/10.18565/aig.2024.93

Khodzhaeva Z.S., Stolyarova E.V., Kholin A.M., Gus A.I.

1) Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, Moscow, Russia; 2) Patrice Lumumba Peoples’ Friendship University of Russia, Moscow, Russia

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.

Authors’ contributions: Khodzhaeva Z.S. – research supervision, writing and final editing the text of the article; Stolyarova E.V. – writing the text of the article; Kholin A.M. – selection of literature sources, editing the text of the article; Gus A.I. – editing the text of the article.
Conflicts of interest: Authors declare lack of the possible conflicts of interests.
Funding: The study was performed within the framework of the research work No. 121040600408-4 of the state assignment of the Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, for 2023–2024.
For citation: Khodzhaeva Z.S., Stolyarova E.V., Kholin A.M., Gus A.I. Analytical review of the national and international clinical guidelines for the management of pregnancies complicated by fetal growth restriction.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (8): 5-13 (in Russian)
https://dx.doi.org/10.18565/aig.2024.93

Keywords

fetal growth restriction
small for gestational age
clinical guidelines
ultrasound
Doppler color flow mapping
computerized cardiotocography
Full text (in Russian)

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Received 16.04.2024

Accepted 20.07.2024

About the Authors

Zulfiya S. Khodzhaeva, Dr. Med. Sci, Professor, Deputy Director, Institute of Obstetrics, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, +7(495)438-07-88, z_khodzhaeva@oparina4.ru,
https://orcid.org/0000-0001-8159-3714
Elizaveta V. Stolyarova, PhD student, 1st Obstetric Department of Pregnancy Pathology, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, +7(495)438-07-74, ev_stolyarova@oparina4.ru,
https://orcid.org/0009-0001-2049-3119
Alexey M. Kholin, PhD, Head of the Department of Telemedicine, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, +7(495)438-25-38, a_kholin@oparina4.ru, https://orcid.org/0000-0002-4068-9805
Alexander I. Gus, Dr. Med. Sci., Chief Researcher at the Department of Ultrasound and Functional Diagnostics, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4; Head of the Department of Ultrasound Diagnostics, Medical Institute, Patrice Lumumba Peoples’ Friendship University of Russia, +7(495)438-11-77, a_gus@oparina4.ru, https://orcid.org/0000-0003-1377-3128

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