From the Guidelines
At 33 weeks of gestation, it is crucial to prioritize check-ups and interventions that focus on fetal growth restriction (FGR) management, as recommended by the Society for Maternal-Fetal Medicine 1.
Recommended Check-ups and Interventions
- Routine prenatal visit with blood pressure monitoring, weight check, fundal height measurement, and fetal heart rate assessment to check for signs of preeclampsia and assess fetal position.
- Ultrasound examination to assess fetal growth and detect any potential complications, as recommended for early-onset FGR (<32 weeks of gestation) 1.
- Serial umbilical artery Doppler assessment to assess for deterioration in fetal growth, with weekly evaluations suggested for pregnancies with decreased end-diastolic velocity or severe FGR (estimated fetal weight less than the 3rd percentile) 1.
- Doppler assessment up to 2-3 times per week when umbilical artery absent end-diastolic velocity is detected, due to the potential for deterioration and development of reversed end-diastolic velocity 1.
- Consideration of delivery at 33-34 weeks of gestation for pregnancies with FGR and absent end-diastolic velocity, as recommended by the Society for Maternal-Fetal Medicine 1.
- Administration of antenatal corticosteroids if delivery is anticipated before 33 6/7 weeks of gestation, to promote fetal lung maturity and reduce the risk of respiratory distress syndrome 1.
Additional Recommendations
- Fetal diagnostic testing, including chromosomal microarray analysis, should be offered when FGR is detected and a fetal malformation, polyhydramnios, or both are also present, regardless of gestational age 1.
- Weekly cardiotocography testing after viability for FGR without absent/reversed end-diastolic velocity, with increased frequency when FGR is complicated by absent/reversed end-diastolic velocity or other comorbidities or risk factors 1.
- Hospitalization, administration of antenatal corticosteroids, heightened surveillance with cardiotocography, and consideration of delivery should be considered in the setting of reversed end-diastolic velocity 1.
From the Research
Check-ups at 33 Weeks of Gestation
At 33 weeks of gestation, the following check-ups and interventions are recommended:
- Monitoring of blood pressure to detect any signs of preeclampsia, a condition that can increase the risk of complications for both the mother and the baby 2, 3
- Screening for gestational diabetes mellitus (GDM), which can increase the risk of preeclampsia and other complications 2, 4
- Assessment of fetal growth and development, including measurement of fetal weight and monitoring of fetal movement 4
- Discussion of lifestyle changes to reduce the risk of future cardiovascular disease, including diet, exercise, and stress management 5
Interventions at 33 Weeks of Gestation
The following interventions may be recommended at 33 weeks of gestation:
- Administration of acetylsalicylic acid to prevent preeclampsia in high-risk women 3
- Probiotic interventions to reduce the risk of preeclampsia and GDM 6
- Individualized care and support for women with a history of preeclampsia or GDM, including counseling and education on lifestyle changes and risk reduction 5
Risk Factors at 33 Weeks of Gestation
The following risk factors should be considered at 33 weeks of gestation: