Evaluating the Growth Assessment Protocol for stillbirth prevention: progress and challenges.

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Public Health

Background:

• Stillbirths are frequently linked to fetal growth restriction, indicating potential preventability.
• Antenatal detection of small for gestational age (SGA) is a key indicator of quality antenatal care.
• Effective evaluation of prevention programs requires robust implementation and realistic assessment.

Purpose of the Study:

• To evaluate the impact of the Growth Assessment Protocol (GAP) on stillbirth rates and SGA detection.
• To assess the effectiveness of a multidisciplinary program in a real-world setting.
• To determine the causal association between GAP implementation and changes in stillbirth rates.

Main Methods:

• Utilized an observational, 10-year study analyzing stillbirth data in England.
• Assessed the effect of the Growth Assessment Protocol (GAP) implemented as a multidisciplinary program.
• Focused on evidence-based care pathways, risk assessment, customized fetal growth surveillance, and rolling audit.

Main Results:

• Demonstrated a strong, causal association between GAP implementation and improved antenatal detection of SGA.
• Observed a sustained decline in national stillbirth rates correlating with GAP adoption.
• Confirmed the effectiveness of observational studies for evaluating program impact in practice.

Conclusions:

• The Growth Assessment Protocol (GAP) is causally associated with reduced stillbirth rates through enhanced SGA detection.
• The program's success highlights the importance of evidence-based care pathways and quality indicators.
• Adapting GAP for low- and middle-income settings is crucial for addressing the global stillbirth burden.