Retrospective Cohort Study of Foetal Growth Restricted Births After 40 Weeks at an Australian Tertiary Maternity...

Foetal growth restriction (FGR) increases risks of neonatal morbidity and mortality. Identifying and preventing FGR is key to improving neonatal outcomes. FGR risk assessment tools are designed to recognise women at high risk of FGR.

This study aims to compare the theoretical effectiveness of four different FGR risk factor assessment pathways in identifying women at risk for FGR: New South Wales (NSW) Foetal Safety Risk Assessment, Safer Baby Bundle FGR pathway, NHS Saving Babies' Lives risk assessment tool and RCOG Screening for Small Gestational Age foetus pathway. These pathways recommend management plans for women identified to be at risk for FGR.

This retrospective study at Westmead Hospital compared singleton births between 2018 and 2021 that were ≥ 40 weeks' gestation with birthweight < 3rd percentile, against the four FGR pathways. Prior to 2022, NSW had no recommended algorithm to identify patients at risk for FGR.

116 women and 116 growth-restricted babies were included for analysis. The NSW Foetal Safety Risk Assessment would have identified 32 (27.6%) women to be at risk for FGR, the Safer Baby Bundle 39 (33.6%), the NHS tool 44 (37.9%) and the RCOG pathway 36 (30%). 32 (23%) babies required neonatal intensive care or special care nursery admission with no neonatal deaths or stillbirths.

Foetal risk assessment tools increase identification of women at risk of FGR, although none are perfect. Ongoing improvements to risk assessment algorithms will help identify larger cohorts of patients at risk of FGR and reduce poor neonatal outcomes.