Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark.
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Acta Obstet Gynecol Scand. 2021 May;100(5):893-899. doi: 10.1111/aogs.14048. Epub 2021 Jan 12.
The objective of this study was to explore the association between detection of fetal growth restriction and maternal-, healthcare provider- and organizational factors.
A historical, observational, multicentre study. All women who gave birth to a child with a birthweight <2.3rd centile from 1 September 2012 to 31 August 2015 in Zealand, Denmark, were included. The population was identified through the Danish Fetal Medicine Database. Medical charts were reviewed to obtain data regarding maternal characteristics and information on the healthcare professionals. Date of authorization for the midwives and obstetricians involved was extracted from the Danish Health Authorization Registry. Multivariable Cox regression models were used to identify predictors of antenatal detection of fetal growth restriction, and analyses were adjusted for hospital, body mass index, parity, the presence of at least one risk factor and experience of the first midwife, number of midwife visits, number of visits to a doctor, the experience of the consultant midwife or the educational level of the doctor, the number of scans and gaps in continuity of midwife-care. Antenatal detection was defined as an ultrasound estimated fetal weight <2.3rd centile (corresponding to -2 standard deviations) prior to delivery.
Among 78 544 pregnancies, 3069 (3.9%) had a fetal growth restriction. Detection occurred in 31% of fetal growth-restricted pregnancies. Clinical experience (defined as years since graduation) of the first consultation midwife was positively associated with detection, with a hazard ratio [HR] of 1.15, 95% confidence interval [CI] 1.03-1.28), for every 10 years of additional experience. The hazard of detection increased with the number of midwife consultations (HR 1.15, 95% CI 1.05-1.26) and with multiparity (HR 1.28, 95% CI 1.03-1.58). After adjusting for all covariates, an unexplained difference between hospitals (P = .01) remained.
The low-risk nullipara may constitute an overlooked group of women at increased risk of antenatal non-detection of fetal growth restriction. Being screened by experienced midwives during early pregnancy and having access to multiple midwife consultations may improve future diagnosis.
本研究旨在探讨胎儿生长受限的检测与产妇、医疗保健提供者和组织因素之间的关联。
一项历史、观察性、多中心研究。所有 2012 年 9 月 1 日至 2015 年 8 月 31 日期间在丹麦西兰岛出生的出生体重低于第 2.3 百分位数的儿童的母亲均被纳入研究。该人群通过丹麦胎儿医学数据库进行识别。对病历进行了回顾，以获取有关产妇特征的信息和有关医疗保健专业人员的信息。从丹麦健康授权登记处提取了参与的助产士和产科医生的授权日期。多变量 Cox 回归模型用于确定产前检测胎儿生长受限的预测因素，分析调整了医院、体重指数、产次、至少存在一个危险因素和第一个助产士的经验、助产士就诊次数、就诊次数、顾问助产士的经验或医生的教育水平、扫描次数和助产士连续护理的差距。产前检测定义为分娩前超声估计胎儿体重<第 2.3 百分位数（对应-2 个标准差）。
在 78544 例妊娠中，有 3069 例（3.9%）发生胎儿生长受限。在 31%的胎儿生长受限妊娠中发现了胎儿生长受限。首次咨询助产士的临床经验（定义为毕业后的年限）与检测呈正相关，每增加 10 年的额外经验，风险比（HR）为 1.15，95%置信区间（CI）为 1.03-1.28）。检测的风险随着助产士咨询次数的增加而增加（HR 1.15，95%CI 1.05-1.26）和多胎妊娠（HR 1.28，95%CI 1.03-1.58）。调整所有协变量后，医院之间仍存在未解释的差异（P=.01）。
低风险初产妇可能构成一个被忽视的群体，她们在产前检测胎儿生长受限方面的风险增加。在妊娠早期由经验丰富的助产士进行筛查，并可多次接受助产士咨询，可能会改善未来的诊断。
