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Evaluating the Growth Assessment Protocol for stillbirth prevention: progress and challenges
Emily Butler1, Oliver Hugh1, Jason Gardosi1
1Perinatal Institute, Birmingham, UK.
Insights
The Growth Assessment Protocol (GAP) program significantly reduced stillbirth rates by improving antenatal detection of small for gestational age (SGA) babies. This evidence-based approach offers a potential solution for stillbirth prevention globally.
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.
Abstract:
Many stillbirths are associated with fetal growth restriction, and are hence potentially avoidable. The Growth Assessment Protocol (GAP) is a multidisciplinary program with an evidence based care pathway, training in risk assessment, fetal growth surveillance with customised charts and rolling audit. Antenatal detection of small for gestational age (SGA) has become an indicator of quality of care. Evaluation is essential to understand the impact of such a prevention program. Randomised trials will not be effective if they cannot ensure proper implementation before assessment. Observational studies have allowed realistic evaluation in practice, with other factors excluded that may have influenced the outcome. An award winning 10 year study of stillbirth data in England has been able to assess the effect of GAP in isolation, and found a strong, causal association with improved antenatal detection of SGA babies, and the sustained decline in national stillbirth rates. The challenge now is to apply this program more widely in low and middle income settings where the main global burden of stillbirth is, and to adapt it to local needs and resources.
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