Fetal Growth Restriction at a Universal Late Third‐Trimester Scan and Relationship With Adverse Outcome: Retrospective Cohort Study

Journal article

Objective: To examine the contribution of fetal growth restriction ultrasound phenotypes to adverse perinatal outcomes at term. Design: Retrospective population‐based cohort study. Setting: John Radcliffe Hospital, Oxford, UK where universal ultrasound at 35+1–36+6 weeks is performed. Population: Congenital abnormalities and births before the scan were excluded. Singleton foetuses were categorised as five mutually exclusive phenotypes using a hierarchical approach: ISUOG fetal growth restriction (FGR), according to Delphi criteria; Constitutional small‐for‐gestational‐age (SGA) (estimated fetal weight [EFW] < 10th centile); Appropriate‐for‐gestational‐age (AGA) with either cerebroplacental ratio < 5th centile or umbilical artery >95th centile; AGA with slowing abdominal circumference growth velocity (ACGV < 10th centile); Normal AGA; Methods: Univariate logistic regression was employed using normal AGA as the reference group to estimate odds ratio with 95% confidence intervals. Group differences for continuous variables were assessed using mean differences with confidence intervals through a generalised linear model. Main Outcome Measures: Stillbirth (SB); composite adverse outcome (CAO) (1+ of Grade 2–3 encephalopathy, cooling, ventilation > 24 h, or perinatal death); severe SGA at birth; neonatal unit admission; obstetric interventions. Results: Among 45 179 pregnancies, 54 SBs (0.1%) and 253 CAOs (0.6%) occurred. Normal AGA foetuses at the 35+1–36+6 week scan accounted for 82% of all pregnancies and for 43 (79.6%) SBs and 205 (81%) with the CAO, yet only 37.3% of neonates born with severe SGA. The absolute risk of SB and CAO was similar in all groups (0.1%–0.2%). Conclusions: Term FGR and ‘normal’ babies have similar perinatal risks, presumably because of intervention. Despite a detection rate of 62.7% for severe SGA, most adverse outcomes occurred in pregnancies with a normal scan.

Authors: D'Alberti, E; Granieri, C; Ioannou, C; Aye, CY; Shea, M

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Wiley
• Journal: BJOG: An International Journal of Obstetrics & Gynaecology
• Article number: 1471-0528.70207
• Publication date: 2026-03-08
• Acceptance date: 2026-02-24
• DOI: 10.1111/1471-0528.70207
• EISSN: 1471-0528
• ISSN: 1470-0328
• Language: English
• Keywords: adverse perinatal outcomes; universal scan; third trimester; fetal growth restriction; small‐for‐gestational‐age; stillbirth