Fetal growth surveillance - Current guidelines, practices and challenges

Area of Science:

• Maternal-Fetal Medicine
• Diagnostic Ultrasound
• Perinatal Epidemiology

Background:

• Antenatal surveillance of fetal growth is crucial for preventing stillbirth and perinatal morbidity.
• Fetal growth restriction (FGR) detection is vital for optimal maternity care outcomes.
• Current ultrasound resources face increased demand due to new FGR surveillance guidelines.

Purpose of the Study:

• To evaluate the impact of customized growth charts and enhanced surveillance protocols on FGR detection.
• To assess the effectiveness of training, e-learning, and audit in improving antenatal detection of small for gestational age (SGA) babies.
• To identify areas for improvement in ultrasound service quality assurance and resource allocation for fetal growth monitoring.

Main Methods:

• Implementation of customized fetal growth charts and plotting of estimated fetal weight.
• Utilizing regular third-trimester ultrasound biometry for high-risk pregnancies.
• Incorporating clinician training, e-learning modules, and audit into the growth assessment protocol.

Main Results:

• Customised growth charts effectively differentiate constitutional from pathological smallness, reducing unnecessary referrals.
• Antenatal detection rates of small for gestational age (SGA) babies have increased.
• Avoidable stillbirths have been reduced following protocol implementation.

Conclusions:

• Customized growth charts and structured protocols enhance antenatal detection of FGR, contributing to reduced stillbirths.
• Missed case audits indicate persistent challenges requiring attention to quality assurance in ultrasound services.
• Addressing resource limitations and quality assurance is essential for further optimizing fetal growth surveillance.