514 Impact of a hybrid model of prenatal care on the diagnosis of fetal growth restriction

Abstract

Fetal growth restriction (FGR) is associated with poor neonatal outcomes and stillbirth, and antenatal screening via fundal height or ultrasound is routinely performed. During the COVID-19 pandemic, we developed a prenatal care schedule that limited in-person care. We sought to determine if FGR diagnoses decreased with this model of care. This was a retrospective cohort study of singleton non-anomalous neonates with birthweights <10%ile. Birthweight was defined using curves by Oken et al. The routine group were those born April-July 2019 with routine prenatal care, and the hybrid group were those born April-July 2020 with both in-person and telemedicine prenatal care dictated by risk (Table 1). The primary outcome was the rate of missed FGR diagnosis. A secondary outcome was time of diagnosis. Neonatal adverse events were also reviewed. Data were abstracted via REDCap. 1345 routine and 1296 hybrid births occurred in the study periods. The number of in-person prenatal care visits decreased from 15,024 in the routine period to 7727 during the hybrid period. 3265 telemedicine visits occurred during the hybrid period. The total number of prenatal care patients remained stable at 3993 and 3753 over the time periods. Third trimester ultrasounds decreased from 2929 to 2014 between periods. FGR occurred in 115 (8.6%) births during the routine and 79 (6.1%) births during the hybrid period. 44/115 (38.5%) cases of FGR were detected in the routine group vs 28/79 (35.4%) in the hybrid group (p=0.76) (Figure 1). Among all births affected by FGR, the median number of in-person visits differed routine vs hybrid groups (11 vs 9 p=<0.001) as did the number of telemedicine visits (0 vs 1 p=<0.001). Median gestational age at diagnosis did not vary between groups (36 vs 37 weeks, p=0.44). Neonatal outcomes (NICU admission, hypoglycemia, and Apgar scores <7) were similar between groups, though limited by sample size. Our hybrid prenatal care protocol did not alter the detection of FGR. Future efforts should explore the benefits of incorporating telemedicine into prenatal care.View Large Image Figure ViewerDownload Hi-res image Download (PPT)