Reduction of stillbirths in England from 2008 to 2017 according to uptake of the Growth Assessment Protocol: 10‐year population‐based cohort study

Abstract

What are the novel findings of this work? There has been a sustained decline in stillbirths in England, which coincided with increased awareness of fetal growth restriction as a potentially avoidable cause of stillbirth, and guidelines to improve antenatal detection. The reduction in stillbirth rates has been accelerated through implementation of the Growth Assessment Protocol. What are the clinical implications of this work? The study found a dose dependent relationship between adherence to evidence based risk assessment and growth surveillance, and extent of benefit gained; units with best antenatal detection rates of SGA had the steepest decline in stillbirth rates, which emphasises the need to prioritise this aspect of maternity service provision. This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process which may lead to differences between this version and the Version of Record. Please cite this article as

Evaluation of the Growth Assessment Protocol (GAP) for antenatal detection of small for gestational age: The DESiGN cluster randomised trial

“…A recent observational study of GAP implementation across the UK also described variation in implementation using nonstandardised outcomes. Their analysis demonstrated a greater reduction of stillbirth rates in maternity units that had completely implemented GAP (defined by reporting the birthweight and outcomes of more than 75% of births via the GAP online tool) compared with those that did not implement GAP [ 34 ]. A third of maternity units (31%; n = 29/94) implementing GAP achieved only partial implementation.…”

Fetal weight projection model to define growth velocity and validation against pregnancy outcome in a cohort of serially scanned pregnancies

“…Data sources were two routinely collected, fully anonymized databases: (1) the perinatal episode electronic record (PEER), a previously described 4 regional health service register which was in operation in all 19 National Health Service (NHS) maternity hospitals in the West Midlands, UK, from 2009 to 2012 ( n = 161 936); and (2) data from the 30 NHS hospitals with maternity information systems that are running the Growth Assessment Protocol (GAP) 11,23 , a program for fetal growth surveillance used in most UK maternity units (2018 to 2021; n = 92 899). Ethics committee approval was not required for this study as all data were recorded prospectively as part of routine care and were fully anonymized before being released for analysis.…”

Learning from cross‐country differences in stillbirth rates—Where to now?

“…As abstracted from the tables in the paper and in supplemental material, the Figure 1 highlights the temporal change in the gestational age distribution and the marked differences in WA compared with Wales. Obstetric interventions when risks of stillbirth are elevated, such as for small for gestational age births or at late‐term pregnancies, have been associated with decreased stillbirth rates and this emerges as a major hypothesis explaining the differences between the countries 7,8 . An analysis of other risk factors confirms associations with maternal age, foetal growth restriction and social deprivation, as measured using an area‐based score, with these factors having more prominence in later stillbirths; these analyses do not, however, offer major clues as to why there would be such large differences between the countries.…”