GAP Care Pathway

Algorithm for risk assessment, surveillance and management of fetal growth

DRAFT 4.7.19
Risk assessment 1 Fetal growth surveillance 3 Further investigation and management 4 Delivery

Regular FH measurements N Term

Serial FH measurements
plotted on GROW chart A
Low Risk from 26-28 weeks N
2-3 weekly until delivery N Normal
Slow growth 3 or
U/S EFW, LV, UAD
FH <10th centile A Abnormal
A

Unsuitable for FH 3
BMI ≥35 Regular EFW measurements N Term
Large (>6cm) or Serial scan EFWs
multiple Fibroids A
plotted on GROW chart from
28 weeks, EFW 3rd -10th centile,
3 weekly until delivery N with normal growth 3 > 39 wks
Moderate risk (any) Suspected late onset FGR: and normal Dopplers
Previous SGA birth Weekly UAD & LV,
Maternal age ≥40 Slow growth 3 or
EFW <10th centile EFW every 2 weeks, EFW<3rd or slow growth 3, or abnormal
Smoker (any) MCA from 34 weeks A 37 wks
Drug misuse UA, UtA, MCA or CPR

High risk (any)

3+ moderate risk factors 2
Medical history Term
HT, AID (SLE, APLS), N
N
cyanotic CHD, kidney D Serial scan EFWs
Uterine Artery A plotted on GROW chart
Obstetric history Suspected early onset FGR
Doppler 20-23w 2 from 28 weeks, Fetal Medicine
FGR, PET, HT, Stillbirth
3 weekly until delivery A absent or reversed UA end-diastolic flow, specialist review,
Current pregnancy
abnormal ductus venosus Doppler management & delivery 4
PAPP A <5th centile
or abnormal computerised CTG
Echogenic bowel
Significant bleeding
EFW<10th at anomaly scan 2

Abbreviations: FH = fundal height; EFW = estimated fetal weight; SGA = small for gestational age; FGR = fetal growth restriction; BMI = body mass index; HT=hypertension; AID = autoimmune disease; SLE=systemic lupus
erythematosus; APLS = antiphospholipid syndrome; CHD = coronary heart disease; PET = pre-eclampsia; kidney D= kidney disease. LV=Liquor volume; Dopplers: UA = umbilical artery; UtA = uterine artery; MCA = middle
cerebral artery; CPR= cerebro-placental ratio; Superscript numbers refer to the sections in the accompanying explanatory notes.