title: Definition and management of fetal growth restriction: a survey of contemporary attitudes.
abstract: OBJECTIVE
  To evaluate opinions among Irish obstetricians and obstetric trainees regarding the optimal definition, assessment and management of pregnancies affected by intrauterine growth restriction (IUGR).
  
  
  METHODS
  An anonymous, structured, web-based survey that comprised 14 questions was sent to 200 obstetricians and obstetric trainees in Ireland.
  
  
  RESULTS
  Of the 113 participants (57% response rate), the majority (50%) were consultants, with over 10 years' clinical experience (46%), who worked in large maternity units (58%) with neonatal units providing care for preterm IUGR fetuses (94%). Eighty-three clinicians (74%) agreed that an estimated fetal weight (EFW) below the 10th centile constitutes small-for-gestational age (SGA). The majority (n=93; 82%) would deliver the SGA fetus between 37(+0) and 39(+6) weeks gestation. In total, the survey yielded 30 different IUGR definitions; the top three definitions were (i) an EFW below the 5th centile (n=18; 16%), (ii) an EFW below the 10th centile with oligohydramnios and abnormal umbilical artery (UA) Doppler (n=16; 14%), and (iii) an EFW below the 10th centile (n=12; 11%). In the evaluation of the preterm IUGR fetus with abnormal UA Doppler, the assessment of amniotic fluid volume, middle cerebral artery, ductus venosus, cardiotocograph (CTG) and biophysical profiling was performed in 74%, 60%, 60%, 54% and 52% respectively. The majority of clinicians applied three or more assessment modalities and 60% referred to a maternal-fetal medicine (MFM) subspecialist. Interestingly, even among MFM subspecialists there was no common consistent management approach. Most doctors (81%) would deliver the IUGR fetus for CTG abnormalities but MFM subspecialists more commonly deliver on the basis of absent end-diastolic flow in the UA alone (37% vs. 10%; p=0.006). Two-thirds of doctors (n=74) would implement customised growth charts if they became available for their population and over 80% thought that a national guideline on IUGR would be beneficial.
  
  
  CONCLUSIONS
  The results of this survey confirm the inconsistencies surrounding the clinical management of IUGR pregnancies and highlight the need for standardisation of terminology and antenatal surveillance, implementation of fetal weight customisation and national guidance for Ireland.
authors.affiliation: Royal College of Surgeons in Ireland, Dublin, Ireland. Electronic address: juliaunterscheider@rcsi.ie.
authors.forename: Julia
authors.initials: J
authors.lastname: Unterscheider
authors.affiliation: Coombe Women and Infants University Hospital, Dublin, Ireland.
authors.forename: Sean
authors.initials: S
authors.lastname: Daly
authors.affiliation: Rotunda Hospital, Dublin, Ireland.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Geary
authors.affiliation: UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland.
authors.forename: Mairead M
authors.initials: MM
authors.lastname: Kennelly
authors.affiliation: UCD School of Medicine and Medical Science, National Maternity Hospital, Dublin, Ireland.
authors.forename: Fionnuala M
authors.initials: FM
authors.lastname: McAuliffe
authors.affiliation: University College Cork, Cork University Maternity Hospital, Cork, Ireland.
authors.forename: Keelin
authors.initials: K
authors.lastname: O'Donoghue
authors.affiliation: Royal Jubilee Maternity Hospital, Belfast, Ireland.
authors.forename: Alyson
authors.initials: A
authors.lastname: Hunter
authors.affiliation: National University of Ireland, Galway, Ireland.
authors.forename: John J
authors.initials: JJ
authors.lastname: Morrison
authors.affiliation: Mid-Western Regional Maternity Hospital, Limerick, Ireland.
authors.forename: Gerard
authors.initials: G
authors.lastname: Burke
authors.affiliation: Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Dicker
authors.affiliation: Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Tully
authors.affiliation: Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Fergal D
authors.initials: FD
authors.lastname: Malone
mesh_terms: D000653:Amniotic Fluid; D001291:Attitude of Health Personnel; D015148:Cardiotocography; D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis* / Q000628:therapy*; D005865:Gestational Age; D019538:Health Care Surveys; D006801:Humans; D007234:Infant, Premature; D007236:Infant, Small for Gestational Age; D007494:Ireland; D008511:Medicine; D009774:Obstetrics / Q000193:education / Q000379:methods*; D011247:Pregnancy; D011795:Surveys and Questionnaires; D014463:Ultrasonography; D014469:Umbilical Arteries / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000503:physiopathology
keywords: Definition; Fetal growth restriction; Management; Survey