CLINICAL DECISION SUPPORT  ·  SMFM #52

Fetal Growth Restriction Manager

UA Doppler-driven delivery windows and surveillance schedules based on SMFM Consult Series #52. Corticosteroid eligibility, BPP flagging, and countdown to target delivery — all in one open-source tool.

▶ Launch FGRManager View Thresholds
Protocol
SMFM #52
Doppler Tiers
4 + Normal
Use
Educational / QA
fgr_clinical_plan.json
Patient Inputs
gestational_age:31w5d
efw_percentile:2nd
ua_doppler:REDF
bpp_score:8/10
Clinical Decision Output
risk_tier:Highest Risk
delivery_window:30–32 weeks
countdown:⏱ At/past window
corticosteroids:Consider / Indicated
Surveillance Schedule
Consider inpatient admission
CTG / NST: 1–2× per day
UA Doppler: 2–3× per week
MCA + ductus venosus: per MFM
⚠ Deliver 30–32 weeks per SMFM #52
Features

Everything you need for FGR management

Built by an MFM physician for real clinical workflow — not a checkbox tool.

📈
SMFM #52 Delivery Thresholds
Implements all four UA Doppler tiers: REDF (30–32w), AEDF (33–34w), decreased diastolic flow (~37w), and severe FGR with normal UA (~37w). Normal UA EFW 3–10th → 38–39w.
🕑
Delivery Countdown Badge
Calculates weeks and days remaining from current GA to the target delivery window midpoint. Instantly flags when the patient is at or past the recommended window.
📋
Surveillance Schedule
Doppler-category–specific NST/BPP frequency, UA Doppler interval, growth scan cadence, and MCA/ductus venosus guidance — tailored to each risk tier.
💉
Corticosteroid Eligibility
Auto-detects standard (<34w) and late-preterm (34–36+6w) thresholds with betamethasone dosing note. Flags when steroids are indicated based on GA and Doppler category.
⚠
BPP Alert System
Color-coded flags for BPP 6/10 (amber — potentially nonreassuring) and ≤4/10 (red — delivery consideration). Contextual guidance for each score tier.
🖶
Copy & Print Summary
One-click clipboard export of the full clinical plan as plain text for EMR documentation. Print-optimized CSS removes UI chrome for clean clinical output.
SMFM #52 Protocol

Delivery-timing thresholds

Standardized delivery windows based on umbilical artery Doppler category, per SMFM Consult Series #52 (2020).

UA Doppler Category Risk Tier Delivery Window Surveillance Intensity
Reversed End-Diastolic Flow (REDF) ● Highest Risk 30–32 weeks Intensive — consider inpatient; CTG 1–2×/day; UA Doppler 2–3×/week; MCA + DV per MFM guidance
Absent End-Diastolic Flow (AEDF) ● High Risk 33–34 weeks Very frequent — NST/BPP 2–3×/week; UA Doppler 2×/week; growth scan every 2–3 weeks; MCA per MFM
Decreased Diastolic Flow ● Moderate–High Risk ~37 weeks Frequent — NST/BPP 2×/week; UA Doppler weekly; growth scan every 3 weeks
EFW <3rd %ile, Normal UA (Severe FGR) ● Severe FGR ~37 weeks Frequent — NST/BPP 2×/week; UA Doppler weekly; growth scan every 2–3 weeks
Normal UA, EFW 3–10th %ile ● Elevated Surveillance 38–39 weeks Standard-plus — NST/BPP weekly; UA Doppler every 2–3 weeks; growth scan every 3–4 weeks

ⓘ Delivery windows reflect widely cited SMFM thresholds. Individualize for maternal indications (preeclampsia, HELLP, abruption), NICU capacity, and patient values. This tool does not replace clinical judgment.

Workflow

How it works

Four inputs. Instant clinical decision support. Designed for the bedside, the office, and the board room.

1
Enter Gestational Age
Accepts 32.4, 32+4, or 32w4d format. The parser normalizes all formats to weeks + days for precise countdown calculation.
2
Enter EFW Percentile
Input the estimated fetal weight percentile (0–99). The tool flags severe FGR (<3rd %ile) and adjusts the delivery window accordingly.
3
Select UA Doppler Category
Choose from Normal, Decreased diastolic flow, AEDF, or REDF. This single input drives the SMFM delivery window and surveillance schedule.
4
Generate Plan
Instantly receive the risk tier, delivery window with countdown, surveillance schedule, corticosteroid eligibility, and BPP flag. Copy or print for the chart.
Clinical Use Cases

Built for real workflows

From the antepartum unit to the MFM consult room — FGRManager fits where you work.

🏥
Antepartum Rounds
Quickly verify delivery timing for admitted FGR patients. Generate a printable surveillance plan for nursing orders and confirm steroid eligibility before rounds end.
📋
MFM Consult Documentation
Copy the plain-text summary directly into your EMR consult note. The output includes GA, Doppler category, delivery window, surveillance plan, and protocol basis.
🏫
Resident & Fellow Education
Walk through SMFM #52 thresholds interactively. Change the Doppler category and watch the delivery window, surveillance intensity, and steroid flag update in real time.
📈
Quality Assurance Review
Audit delivery timing decisions against SMFM benchmarks. Verify that surveillance schedules and steroid administration align with evidence-based thresholds.
About the Author
CO
Dr. Chukwuma Onyeije, MD
Maternal-Fetal Medicine Specialist  ·  Physician-Developer  ·  DoctorsWhoCode.blog
Dr. Onyeije is a board-certified MFM specialist and the founder of DoctorsWhoCode.blog and CodeCraftMD — platforms dedicated to the intersection of clinical medicine and software development. FGRManager is part of a growing suite of open-source clinical decision-support tools designed to bring evidence-based protocols to the bedside in a usable, physician-built format.
DoctorsWhoCode.blog ▶ Launch FGRManager
⚠
Informational Use Only
FGRManager is an educational and quality-assurance tool. It does not provide medical advice and is not a substitute for clinical judgment. Delivery timing decisions must account for maternal indications (preeclampsia, HELLP, abruption), fetal anomalies, infection, PPROM, local NICU capabilities, and individual patient values. All therapeutic decisions must be made by a qualified healthcare provider in the context of the individual patient. Protocol basis: SMFM Consult Series #52 (2020) and ACOG Practice Bulletin #204.

Ready to manage FGR with confidence?

Free, open-source, and deployable to any static host. Drop a single HTML file into GitHub Pages and you're live.

▶ Launch FGRManager View SMFM Thresholds