What are the indications for referring a patient with suspected IUGR to a specialist for further evaluation?

Refer a patient with suspected intrauterine growth restriction (IUGR) to a specialist for further evaluation if:

• There is a concern of small for gestational age based on symphysis fundal height measurement, especially if accompanied by additional clinical findings such as reduced fetal movements or raised maternal blood pressure, warranting an urgent ultrasound scan for fetal growth and wellbeing ¹.
• In multiple pregnancies, particularly monochorionic twins or triplets, if there is an estimated fetal weight (EFW) discordance of 20% or more and/or the EFW of any fetus is below the 10th centile for gestational age, increased monitoring and referral to a named specialist obstetrician is indicated ².
• For monochorionic twins or triplets, referral to a tertiary level fetal medicine centre is recommended if there is an EFW discordance of 25% or more combined with any fetus having an EFW below the 10th centile, as this indicates selective fetal growth restriction ².