Risk factor assessment for fetal growth restriction, are we providing best care?

Abstract

INTRODUCTIONThe timely detection of fetal growth restriction (FGR) remains challenging. 1 Over half of growth-restricted babies remain unrecognised before birth. 1,2 This is important because, if undetected, the risk of stillbirth in pregnancies complicated by FGR is eightfold higher than in normal pregnancies. 3 Improving the detection of FGR would therefore be expected to reduce the rate of stillbirth. 1,4 One approach to improving the detection of FGR is to risk-stratify women in early pregnancy and to offer targeted ultrasound assessment of fetal growth, as recommended by the Royal College of Obstetricians and Gynaecologists (RCOG). 5 The RCOG guideline includes a risk assessment tool for clinicians to use routinely in all women at the beginning of pregnancy, 5 variations of which have been adopted by various national guidelines. [6][7][8][9] In Victoria there is no state-wide guideline to support clinicians in identifying women at risk of having a pregnancy complicated by FGR. We wished to explore whether women who have major risk factors for FGR are receiving serial third trimester ultrasound assessment of fetal growth. MATERIALS AND METHODSWe undertook a retrospective, population-based cohort study using data from the Victorian Perinatal Data Collection (VPDC), a state-wide database that has information on every Victorian birth

Widely accessible prognostication using medical history for fetal growth restriction and small for gestational age in nationwide insured women

“…15,16 Meanwhile, there was an association detected of FGR/SGA with a woman's medical history. 17 Because a health insurance claim database abundantly records medical histories, this allows proactive screening for FGR/SGA, particularly in countries with universal health coverage. 18 Screening by medical history is also independent of the number of pregnancy consultations on which FGR detection depends (hazard ratio 1.15, 95% confidence interval [CI] 1.05 to 1.26).…”

Prognosticating Fetal Growth Restriction and Small for Gestational Age by Medical History

“…Current methods using ultrasound or biomarkers were inaccessible in most settings [4,5]. Meanwhile, a health insurance claim database abundantly records medical history of which association [6] with FGR/SGA allows its proactive screening, particularly in countries with universal health coverage [7]. However, studies have yet to develop a screening method for FGR/SGA using medical history.…”