Improving perinatal outcome by a dedicated fetal growth clinic

Abstract

Intrauterine growth restriction (IUGR) is a recognised cause of morbidity and mortality and a common indication for induction of labour. Such inductions are not uncommonly complicated by high caesarean section rates. Since 1997, we have been running a dedicated fetal growth clinic (FGC) at Leicester. Criteria for referral to this clinic are well defined. Management of women referred to the clinic is based on an evidenced-based protocol. The aim of this study was to audit the outcome of this clinic and to compare it with that for IUGR cases managed between 1995 and 1996. Clinic records and the maternity database of the Leicester Royal Infirmary for the period 1997–2000 were reviewed. The data for 1995–96 had already been collected as part of the work-up to the setting up of the FGC. Variables collected for analyses included maternal demographic characteristics, gestational at delivery, spontaneous or induced labour, method of delivery, birth weight, umbilical arterial pH where available and admission into the neonatal intensive care unit. Over the 4-year period, 507 cases of IUGR were seen at the FGC, representing 28.9% of the total referrals to the clinic. The mean gestational age and birth weight at delivery were 37.9 (3.4) weeks vs. 36.1 (2.9) weeks and 2645 (350) g vs. 2215 (340) g, respectively, for the study period and that between 1995 and 1996. The CS rates were 25.6% vs. 42.1% and neonatal intensive care admission was 14.5% vs. 36.6%.