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Small-for-Gestational-Age Fetus, Investigation and Management (Green-top Guideline No. 31)


Small-for-gestational age (SGA) refers to an infant born with a birth weight less than the 10th centile. Small fetuses are divided into normal (constitutionally) small, non–placenta-mediated growth restriction (for example: structural or chromosomal anomaly, inborn errors of metabolism and fetal infection) and placenta mediated growth restriction.

Maternal factors can affect placental transfer of nutrients, for example low prepregnancy weight, undernutrition, substance abuse or severe anaemia. Medical conditions can affect placental implantation and vasculature and hence transfer, for example pre-eclampsia, autoimmune disease, thrombophilias, renal disease, diabetes and essential hypertension.

The purpose of this guideline is to provide advice that is based on the best evidence where available to guide clinicians regarding the investigation and management of the SGA fetus. It reviews the risk factors for an SGA fetus and provides recommendations regarding screening, diagnosis and management, including fetal monitoring and delivery. This guideline does not address multiple pregnancies or pregnancies with fetal abnormalities.

COVID disclaimer

This guideline developed as part of the regular programme of Green-top Guidelines, as outlined in our document Developing a Green-top Guideline: Guidance for developers, and prior to the emergence of COVID-19.

Version history

This is the second edition of this guideline; the third edition is currently in development.

Developer declaration of interests

Available on request.

This page was last reviewed 22 March 2013.