Fetal growth assessment

New referral / Follow-up review

Maternal age:

Parity:

BMI:

Medical history:

Medications:

Previous SGA/FGR:

Smoking:

Diabetes:

Hypertension:

CST:

PAPP-A:

PET risk:

GDM risk:

VTE risk:

Hb:

Combined uterine artery PI at anomaly scan:

AC centile at anomaly scan:

EFW centile at anomaly scan:

Today:

Blood pressure:

Urinalysis:

AC velocity (centile change since anomaly scan):

Combined uterine artery PI:

Impression:

Plan: 

Follow-up: