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Why we succeed and fail in detecting fetal growth restriction: A population-based study.

Authors
  • Andreasen, Lisbeth A1, 2
  • Tabor, Ann2, 3
  • Nørgaard, Lone Nikoline3
  • Taksøe-Vester, Caroline A1
  • Krebs, Lone2, 4
  • Jørgensen, Finn S2, 5
  • Jepsen, Ida E6
  • Sharif, Heidi7
  • Zingenberg, Helle8
  • Rosthøj, Susanne9
  • Sørensen, Anne L9
  • Tolsgaard, Martin Grønnebaek1, 2, 10
  • 1 Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark. , (Denmark)
  • 2 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. , (Denmark)
  • 3 Department of Obstetrics, Center of Fetal Medicine and Ultrasound, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. , (Denmark)
  • 4 Department of Obstetrics and Gynecology, University of Copenhagen, Holbaek Hospital, Holbaek, Denmark. , (Denmark)
  • 5 Department of Obstetrics and Gynecology, Fetal Medicine Unit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark. , (Denmark)
  • 6 Department of Obstetrics and Gynecology, University of Copenhagen, Roskilde Hospital, Denmark. , (Denmark)
  • 7 Department of Obstetrics and Gynecology, University of Copenhagen, Naestved Hospital, Denmark. , (Denmark)
  • 8 Department of Obstetrics and Gynecology, Copenhagen University Hospital, Herlev, Denmark. , (Denmark)
  • 9 Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark. , (Denmark)
  • 10 Department of Obstetrics and Gynecology, Copenhagen University Hospital North Zealand, Hillerød, Denmark. , (Denmark)
Type
Published Article
Journal
Acta Obstetricia Et Gynecologica Scandinavica
Publisher
Wiley (Blackwell Publishing)
Publication Date
May 01, 2021
Volume
100
Issue
5
Pages
893–899
Identifiers
DOI: 10.1111/aogs.14048
PMID: 33220065
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. © 2020 Nordic Federation of Societies of Obstetrics and Gynecology.

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