Improving birth outcomes: a prospective audit of the detection and management of small for gestational age (SGA) fetuses

Stillbirth rates in the UK are one of the highest in the developed world. Using ReCoDe classification, 43% of stillbirths can be attributed to intrauterine growth restriction(IUGR). Small for gestational age(SGA); <10th centile on a customized growth chart, is synonymous with IUGR. Risk of stillbirth is reduced when IUGR is detected antenatally compared to undetected. Royal College of Obstetricians and Gynaecologists(RCOG) 2013 guidance stratifies antenatal care in those at risk of SGA. Objectives: Determine whether women identified ‘at risk of SGA’ receive appropriate antenatal care according to RCOG guidance Compare detection rates of SGA in women who received appropriate vs. inappropriate antenatal care according to RCOG guidance; Compare intrapartum management and perinatal outcomes where SGA was detected vs. undetected antenatally. We prospectively collected anonymised data for 494 consecutive singleton deliveries in BH&SCT (8.6% of annual singleton births). Clinical risk for SGA, birth weight, antenatal and intrapartum management and birth outcome data were analyzed using “IBM - Statistical analysis software package - SPSS Statistics.” In total, 33% (165/494) of women were categorized at risk of SGA in accordance with RCOG guidance (minor 42, major 123). Overall, 56% (91/163, 2NA) were managed appropriately antenatally, with 65% (79 of 121, 2 NA) and 29% (12/42) in major and minor risk groups respectively (see Table 4). Across all categories (including ‘low risk) 11% (56/493, 1 missing) of babies were SGA at birth with a 55% (30/55, 1 missing) antenatal detection rate. SGA babies detected antenatally were on average delivered 13 days earlier than their undiagnosed counterparts. A higher proportion were delivered by caesarean section (50% vs 32%), Our data suggests detection of SGA results in earlier delivery and changes the mode of delivery. Further research is required to ascertain whether antenatal detection of SGA impacts intrapartum management and perinatal outcomes.