The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.
Safer Care Victoria, Department of Health and Human Services, Victorian Government, Melbourne, Victoria, Australia.
Aust N Z J Obstet Gynaecol. 2021 Oct;61(5):715-721. doi: 10.1111/ajo.13340. Epub 2021 Mar 26.
Increasing the detection of fetal growth restriction (FGR), while reducing stillbirth, also leads to unnecessary early intervention, and associated morbidity, for normally grown babies who are incorrectly suspected of FGR.
We sought to design a balance measure that addresses the specificity of FGR detection.
A retrospective cohort study on all singleton births ≥32 weeks gestation in 2016 and 2017 in Victoria. We compared two balance measures for the detection of FGR, defined as the proportion of all babies iatrogenically delivered before 39 weeks gestation for suspected FGR that had a birthweight ≥10th centile (balance measure 1) or ≥25th centile (balance measure 2). Hospital level performance on each balance measure was derived and compared to an existing performance measure for severe FGR detection in Victoria.
Of the 38 hospitals analysed, 12 (32%) had a favourable performance on an existing indicator of FGR detection, seven (18%) hospitals had a favourable performance on balance measure 1, and 15 (39%) had a favourable performance on balance measure 2. There was a moderate correlation between hospital performance on the existing indicator and on balance measure 1 (r = 0.447, P = 0.005) but not balance measure 2 (r = -0.063, P = 0.71). There was no difference in perinatal mortality between high performing hospitals and low performing hospitals.
Introducing a balance measure into routine reporting may bring greater awareness to the unintended harm associated with increased detection of FGR.
提高胎儿生长受限（FGR）的检出率，同时降低死产率，也会导致对正常生长的婴儿进行不必要的早期干预，并带来相关的发病率，因为这些婴儿被错误地怀疑患有 FGR。
我们旨在设计一种平衡措施，以解决 FGR 检测的特异性问题。
这是一项在 2016 年和 2017 年维多利亚州所有≥32 周单胎妊娠的回顾性队列研究。我们比较了两种用于检测 FGR 的平衡措施，定义为所有疑似 FGR 的婴儿中，因怀疑 FGR 而在 39 周前人为分娩的比例，其中出生体重≥第 10 百分位数（平衡措施 1）或≥第 25 百分位数（平衡措施 2）。根据每个平衡措施计算了医院的表现，并与维多利亚州严重 FGR 检测的现有指标进行了比较。
在所分析的 38 家医院中，12 家（32%）在现有的 FGR 检测指标上表现良好，7 家（18%）医院在平衡措施 1 上表现良好，15 家（39%）医院在平衡措施 2 上表现良好。医院在现有指标上的表现与平衡措施 1 之间存在中度相关性（r=0.447，P=0.005），但与平衡措施 2 之间无相关性（r=-0.063，P=0.71）。高绩效医院和低绩效医院之间的围产儿死亡率没有差异。
在常规报告中引入平衡措施可能会使人们更加关注因提高 FGR 检出率而导致的意外伤害。
