Late fetal growth restriction: diagnostic challenges and contemporary induction strategies

Abstract

Fetal growth restriction (FGR) remains one of the major challenges of modern obstetrics. Late-onset FGR, diagnosed after 32 weeks of gestation, is the most frequent clinical form and is characterized by subtle Doppler abnormalities and preserved fetal compensatory mechanisms, making obstetrical management particularly complex. Objective. To analyze current diagnostic criteria for late fetal growth restriction and to evaluate recent evidence regarding induction of labour methods in pregnancies complicated by this pathology. Material and methods. A narrative review of recent literature was performed, focusing on modern diagnostic standards established after the Delphi consensus and comparative clinical studies evaluating mechanical and pharmacological induction methods in late FGR pregnancies. Results. The Delphi consensus improved diagnostic standardization by integrating biometric and Doppler criteria. Recent studies demonstrate that mechanical induction methods, particularly Foley balloon and extra-amniotic balloon, are associated with lower rates of uterine tachysystole, cesarean delivery for fetal distress, and neonatal intensive care admission compared with dinoprostone. Conclusions. Late fetal growth restriction requires precise prenatal diagnosis and individualized obstetrical management. Mechanical cervical ripening methods currently appear to offer better maternal and fetal tolerance in many clinical situations.