How should I monitor a patient diagnosed with IUGR throughout their pregnancy to ensure optimal outcomes?

To monitor a patient diagnosed with intrauterine growth restriction (IUGR) throughout pregnancy and ensure optimal outcomes, follow these steps:

• Risk assessment: Conduct a risk assessment for fetal growth restriction at the first antenatal booking appointment and again in the second trimester, using guidance such as the Royal College of Obstetricians and Gynaecologists' guideline on small-for-gestational-age fetuses or the NHS saving babies' lives care bundle version 2 ¹.
• Symphysis fundal height measurement: Measure symphysis fundal height at each antenatal appointment after 24+0 weeks, but no more frequently than every 2 weeks, unless the woman is having regular growth scans. Plot these measurements on a growth chart as per NHS saving babies' lives care bundle ¹.
• Ultrasound scans: If fundal height is small for gestational age or there are additional clinical concerns (e.g., reduced fetal movements, raised maternal blood pressure), offer an ultrasound scan to assess fetal growth and wellbeing. The urgency depends on clinical findings ¹.
• Fetal movement monitoring: Discuss fetal movements with the woman after 24+0 weeks at each antenatal contact, ask about any concerns, and advise her to contact maternity services immediately if she notices reduced fetal movements ¹. Assess the woman and fetus promptly if concerns arise.
• Additional monitoring: Monitor maternal blood pressure and proteinuria at every routine face-to-face antenatal appointment to identify any hypertensive disorders that may complicate IUGR ¹.
• Plan delivery and intrapartum care: Discuss with the woman the risks associated with small-for-gestational-age babies and plan fetal monitoring during labour accordingly, including continuous cardiotocography ².