Accurate assessment of fetal growth is a crucial part of providing safe maternity care. Identifying babies who are not growing as expected allows women to be offered appropriate monitoring and, where necessary, intervention, as part of informed decision-making.
The College’s Green-top Guideline No. 31, ‘The Investigation and Management of the Small–for–Gestational–Age Fetus’, has been updated (21 July 2026) following NHS England's decision to stop using INTERGROWTH.
This revision clarifies support, based on available published evidence, for four estimated fetal weight standards (growth charts): Hadlock, WHO, FMF and GROW and in accordance with current evidence, does not specifically recommend any one over another.
RCOG will continue to review new evidence as it emerges, through our established processes, to ensure our recommendations reflect the strongest available evidence and continue to support safe, consistent care. The next full review of GTG No 31 is currently scheduled for 2027.
The National Maternity and Neonatal Investigation report includes a recommendation to the Department of Health and Social Care and NHS England to fund an independent study of the accuracy of different growth charts available for measuring fetal growth and their ability to reduce adverse outcomes. The RCOG should have a pivotal role in this work.
Through the National Maternity and Neonatal Taskforce, the College is committed to working alongside the government, other professional bodies and representatives with lived experience, to take forward recommendations, and to support safe maternity care across the system.
- Green-top Guideline No. 31, The Investigation and Management of the Small–for–Gestational–Age Fetus here.
- RCOG Supporting Safer Maternity Care programme, available here