Fetal growth restriction is a leading contributor to perinatal death, and management varies more than the evidence justifies. This structured comparison searched Medline to March 2026 and compared six guidelines - from Canada, the United Kingdom, France, the Society for Maternal-Fetal Medicine, the International Society of Ultrasound in Obstetrics and Gynecology, and the International Federation of Gynecology and Obstetrics - across definition, prediction and prevention, surveillance, and management.
The agreements are substantial and worth stating plainly. Doppler is central to risk stratification and delivery timing, with umbilical artery universally and ductus venosus in early-onset disease (the Society for Maternal-Fetal Medicine excepted). All support antenatal corticosteroids and magnesium sulphate where preterm birth is anticipated, early aspirin in high-risk pregnancies, and access to genetic counselling and testing in severe or early-onset restriction with structural anomalies. None recommends universal third-trimester ultrasound in low-risk pregnancy.
The disagreements are where local policy has to make a choice. Whether growth restriction is defined by a biometric threshold or by Delphi consensus criteria; whether angiogenic biomarkers have a routine role; whether low-molecular-weight heparin prevents anything; which growth chart to use; whether the biophysical profile and computerised cardiotocography add value; and how to induce, where mechanical methods are generally preferred on limited evidence. The growth chart question is the one with the sharpest local edge - a chart built on a population unlike yours will misclassify at both ends, and there is no international agreement to fall back on. Write your unit's answers to these six questions down, because at the moment they are being answered differently by different clinicians on different days.
- Write down your unit's definition of fetal growth restriction and which growth chart it uses - the guidelines do not agree, so someone has to decide.
- Doppler-based surveillance is the point of consensus; build the pathway around umbilical artery and, in early-onset disease, ductus venosus.
- Do not offer routine angiogenic biomarkers or low-molecular-weight heparin for prevention outside a trial - both remain contested.
- Universal third-trimester ultrasound in low-risk pregnancy is not recommended by any of the six.
- Growth chart choice matters most where the reference population differs from the population being scanned; misclassification runs in both directions.
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