Article Text
PDF
Abstract
Background Using ReCoDe, 43% of stillbirths in UK studies are attributed to intrauterine growth restriction (IUGR).1 Identification of IUGR remains challenging antenatally. With customised growth charts, a Small for Gestational Age (SGA) fetus, defined as <10th centile, is associated with poor neonatal outcomes including death and is synonymous with IUGR.2 Guidelines help identify and stratify antenatal care in those at risk of SGA.3
Objectives Using RCOG Guideline 31: Ascertain whether patients have accurate assessment and management for SGA risks at booking appointment and determine percentage of women who delivered SGA babies and in how many SGA was diagnosed antenatally.
Methods A 50day, prospective data collection of all deliveries in a tertiary hospital. 846 charts included, 25 not located. Notes reviewed for evidence that fetal surveillance was undertaken where risk factors for SGA existed. Using customised growth charts, we ascertained whether babies were SGA and whether this was detected antenatally.
Results 821 charts reviewed. Overall SGA detection rate was 36%.
Conclusions SGA is often missed antenatally. Correct risk management increases detection of SGA babies. Even in correctly managed high risk women, detection rate was only 56%. Fundal heights and Estimated Fetal Weights on ultrasound are not reliably detecting SGA. Education, skills training and re-configuration of our service is advised.
References
-
Gardosi J, et al. Classification of stillbirth by relevant condition at death (ReCoDe): population based cohort study. British Medical Journal 2005;331:1113–1116
-
Figueras F, Gardosi J. Intrauterine growth restriction: new concepts in antenatal surveillance, diagnosis and management. American Journal of Obstetrics and Gynaecology 2011; 204(4):288–300
-
Royal College of Obstetricians and Gynaecologists. The investigation and management of the Small-for-gestational-age fetus. Guideline No. 31. RCOG: London, 2013
