The RCOG have recently published guidance on referral for serial growth scans based on risk stratification at booking.¹ The aim is to improve the surveillance of the SGA fetus and aid appropriate obstetric intervention in this group of women at high risk of perinatal morbidity and mortality.² This is a retrospective study of 38 patients who delivered over 37 weeks gestation, infants with birthweight <2.5 Kg over a 6 months period. The study evaluates referral for serial growth scans based on risk stratification at booking history or on symphysio-fundal height (SFH) measurements. The results were analysed in two groups, the first having risk factors and the second group without risk factors based on the RCOG guideline (Table 1).

Under current local guidelines only 35% had been referred for scans based on history, risk stratification would increase the referral to 53%. In the high-risk group concerns with the SFH measurements alone would result in 50% being scanned and 87% of the low risk group. This study confirms the value in identifying a high risk group for serial growth scans and highlights the importance of SFH measurements in the low risk group with appropriate referral pathways for serial growth scans.

References

1. The Royal College of Obstetricians and Gynaecologists, Green-Top Guideline No 31, Second Edition. The investigation and management of the small-for-gestational-age fetus February 2013

2. Figueras F, Figueras J, Meler E, et al. Customised birthweight standards accurately predict perinatal morbidity. Arch Dis Child Fetal Neonatal Ed 2007;92:277–80

3. Gardosi J, Francis A. GROW Customised Centile Calculator – GROW-CCC software v 5.1, 2006. Gestation Network, www.gestation.net