Butterfield Eleanor, Skelton Emily
Frimley Health NHS Foundation Trust, Frimley, UK.
School of Health and Psychological Sciences, City, University of London, London, UK.
Ultrasound. 2024 Nov 8:1742271X241287925. doi: 10.1177/1742271X241287925.
Growth Assessment Protocol is a fetal growth initiative designed to improve antenatal detection of babies who are small-for-gestational-age and reduce stillbirths. However, its direct impact on pregnancy outcome and stillbirth rates is questioned. This service evaluation aimed to assess Growth Assessment Protocol's influence on pregnancy outcomes at a National Health Service hospital.
Anonymous, maternity and ultrasound data, routinely acquired between 2014 and 2022 were extracted from clinical databases (Viewpoint, Euroking). Trends in maternity data and ultrasound scan volume were explored with descriptive statistics. Variables of stillbirth, antenatal small-for-gestational-age detection and scan volume were compared before and after Growth Assessment Protocol implementation. Associations between these variables were evaluated using Spearman's rho.
The percentage of babies born small-for-gestational-age reduced by 0.3% across the evaluation period. Antenatal small-for-gestational-age diagnosis rose from 4.1% to 14.3%. However, the number of false-positive cases of antenatally diagnosed small-for-gestational-age increased fivefold from 2.2% to 11.5%. Although stillbirth rates remained consistent post-Growth Assessment Protocol, complex scan volume (e.g. number of growth scans using Doppler) increased annually. The peak incline coincided with the Growth Assessment Protocol implementation period (2016-2018). Complex scan volume was significantly associated with overall small-for-gestational-age detection (rho = 0.8, =< 0.001), but not with stillbirth frequency (rho = -0.1, = 0.4).
Small-for-gestational-age detection increased following Growth Assessment Protocol implementation, although this was associated with a high false-positive rate and no reduction in stillbirths. The potential implications associated with clinical management, parent experiences and departmental workflow, alongside the benefits for stillbirth reduction, should be fully considered prior to the introduction of a new fetal growth initiative to the antenatal care pathway.
生长评估方案是一项旨在改善对小于胎龄儿的产前检测并降低死产率的胎儿生长计划。然而，其对妊娠结局和死产率的直接影响受到质疑。这项服务评估旨在评估生长评估方案对一家国民保健服务医院妊娠结局的影响。
从临床数据库（Viewpoint、Euroking）中提取2014年至2022年期间常规收集的匿名产妇和超声数据。用描述性统计方法探讨产妇数据和超声扫描量的趋势。比较生长评估方案实施前后死产、产前小于胎龄儿检测和扫描量的变量。使用斯皮尔曼等级相关系数评估这些变量之间的关联。
在评估期间，小于胎龄儿出生的百分比下降了0.3%。产前小于胎龄儿诊断率从4.1%上升到14.3%。然而，产前诊断为小于胎龄儿的假阳性病例数从2.2%增加到11.5%，增加了五倍。尽管生长评估方案实施后死产率保持稳定，但复杂扫描量（如使用多普勒的生长扫描次数）每年都在增加。增长峰值与生长评估方案实施期（2016 - 2018年）一致。复杂扫描量与总体小于胎龄儿检测显著相关（相关系数 = 0.8，P <= 0.001），但与死产频率无关（相关系数 = -0.1，P = 0.4）。
实施生长评估方案后，小于胎龄儿检测有所增加，尽管这与高假阳性率相关且死产率没有降低。在将新的胎儿生长计划引入产前护理途径之前，应充分考虑与临床管理、家长体验和科室工作流程相关的潜在影响，以及对降低死产率的益处。
