What management strategies should be implemented for a patient with IUGR to minimize risks to the fetus?

Management strategies for a patient with intrauterine growth restriction (IUGR) to minimize fetal risks include:

• Offer risk assessment for fetal growth restriction at the first antenatal booking appointment and again in the second trimester, using appropriate professional or national guidance such as the Royal College of Obstetricians and Gynaecologists' guideline or the NHS saving babies' lives care bundle version 2.
• Measure symphysis fundal height at each antenatal appointment after 24+0 weeks (no more frequently than every 2 weeks) for singleton pregnancies unless regular growth scans are being performed, and plot measurements on a growth chart.
• If fundal height is small for gestational age, offer an ultrasound scan for fetal growth and wellbeing, with urgency depending on additional clinical findings such as reduced fetal movements or raised maternal blood pressure.
• Discuss fetal movements with the woman after 24+0 weeks, ask about concerns at each antenatal contact, and advise her to contact maternity services promptly if she notices reduced fetal movements.
• Offer continuous cardiotocography during labour for babies suspected to be small for gestational age after a full discussion of benefits and risks, respecting the woman's decision if declined.
• Provide detailed counselling to the woman about the increased risk of serious medical problems for the baby associated with growth restriction, including potential complications during labour and birth.
• Ensure close maternal and fetal monitoring during labour, including continuous fetal heart rate monitoring, to promptly identify and manage any signs of fetal compromise.

These strategies aim to detect growth restriction early, monitor fetal wellbeing closely, and manage labour carefully to reduce risks to the fetus associated with IUGR.

References: NICE NG201, NICE NG121