Fetal growth restriction (FGR) affects around 5% of pregnancies. Failing to detect and manage pregnancies with FGR increases the risk of stillbirth. There are two main challenges to detecting these fetuses. Firstly identifying the group of pregnancies that need growth scans, secondly using growth charts appropriate for the population to diagnose growth restriction. The Royal College has recently released the Small for gestational age guideline, which advises risk stratification from booking and the use of customised growth charts, aiming to reduce perinatal morbidity or mortality.
This retrospective case note review examines 58 cases of fetal deaths in Leicester. An online programme was used to calculate the customised birth weights. The RCOG guideline recommendations were used to ascertain whether the criterion for serial growth scans were met.
In the study population 67% of the population delivered before 34 weeks. 81% would have fulfilled the RCOG criteria for serial scans; the majority of these women do not meet the local criteria for serial growth assessment. Of the early gestation group 52% had a customised birth weight centile less than 10%. Only 40% would have fulfilled the RCOG criteria for serial growth scans.
50% of the population may have been identified on customised charts to be small for gestational age, compared to 29% on population based growth charts. In addition risk stratification would have identified the majority of this cohort as needing serial growth scans. Whether this in turn results in a reduction in the perinatal mortality rate remains to be seen.