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Customised growth charts – how well are we using them?
  1. S Pandey1,
  2. T Rea2
  1. 1Department of Obstetrics and Gynaecology, Stoke Mandeville Hospital, Aylesbury, UK
  2. 2Department of Obstetrics, Milton Keynes Foundation NHS Trust, Milton Keynes, UK

Abstract

Background Every year in the UK one in 200 infants are stillborn. Reliable antenatal identification of small-for-gestational age (SGA) is crucial to improving perinatal outcome. Studies have shown that customised growth charts increase the antenatal detection rate of SGA babies from 29% to 48% (p=0.02).

Methodology The authors reviewed the birth weights of all stillborn babies (n=28) of more than 23 weeks gestational age over 1 year in a district general hospital with a delivery rate of 4000/year. Guided by the findings, the authors then reviewed a random set of 137 notes to see how many SGA babies were picked up antenatally by using customised growth charts.

Results Our study showed that 50% of stillborn babies had a birth weight ≤ the 10th percentile for their gestational age, with half of these being ≤ the second percentile.

Of the further set of 137 deliveries, 40.8% (56/137) had a customised growth chart. 29.9% (41/137) had symphysis fundal height (SFH) plotted on the customised growth chart at least once. Only 21.8% (30/137) had at least 2 SFH readings plotted on the customised growth chart. 11.6% (16/137) of babies had a birth weight ≤ the 10th percentile; only four of these SGA babies had SFH plotted twice or more. Of these four, only one had been diagnosed as SGA antenatally using customised growth charts.

Conclusion Maternity units and community midwives should be encouraged to use customised growth charts. More sensitive screening methods identifying small babies antenatally also need to be urgently explored.

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