TY - JOUR
T1 - Practice variation in diagnosis, monitoring and management of fetal growth restriction in the Netherlands
AU - Marijnen, Mauritia Catharina
AU - Damhuis, Stefanie Elisabeth
AU - Smies, Maddy
AU - Gordijn, Sanne Jehanne
AU - Ganzevoort, Wessel
N1 - Funding Information: We would like to thank the collaborators in the Dutch hospitals who shared their protocol. All authors met the criteria for authorship set by the International Committee of Medical Journal Editors. All authors conceived and designed the study. MM collected all protocols and extracted all data. All authors were involved in data interpretation. MM drafted the manuscript with substantial contributions from all authors. All authors reviewed and approved the final version of the manuscript. None. Publisher Copyright: © 2022 The Authors
PY - 2022/9/1
Y1 - 2022/9/1
N2 - Objectives: Fetal growth restriction (FGR) is a condition characterized by its complexity in diagnosis and management. There is a need for early accurate diagnosis, evidence-based monitoring and management of FGR to improve neonatal outcomes. This study evaluated differences and similarities in protocols of Dutch hospitals in the approach of (suspected) FGR in the context of the national guideline. Study design: FGR protocols were collected from Dutch hospitals between November 2019 and June 2020. Collected data were coded for further analysis and categorized in eight predetermined key domains of definition, preventive measures, testing, referral, monitoring strategies, interventions, mode of delivery and pathologic placenta examination. Results: 55 of 71 approached hospitals (78 %) responded to the request and 54 protocols (76 %) were obtained. Protocols used variable definitions of FGR, and management was mostly based on fetal biometry results in combination with Doppler results (n = 47, 87 %). In pregnancies with an abdominal circumference (AC) or an estimated fetal weight (EFW) <10th percentile with normal Doppler results, induction of labour was recommended ≥37 weeks (n = 1, 2 %), ≥38-40 weeks (n = 23, 43 %); ≥41 weeks (n = 1, 2 %) or not specified (n = 29, 54 %). In case of an umbilical artery (UA) Doppler pulsatility index >95th percentile, (preterm) labour induction was recommended in the majority of the protocols regardless of fetal size (≥36 weeks: n = 2, 4 %; ≥37 weeks: n = 41, 76 %, not stated: n = 11, 20 %). Conclusion: This study found practice variation in all predetermined domains of FGR protocols of Dutch hospitals, underscoring the complexity of the condition. The differences found in this study feed the research agenda that informs the process of improving obstetric care by better identification of the fetus at risk for consequences of FGR, improving evidence-based monitoring strategies to identify (imminent) fetal hypoxia, and more accurate timing of delivery.
AB - Objectives: Fetal growth restriction (FGR) is a condition characterized by its complexity in diagnosis and management. There is a need for early accurate diagnosis, evidence-based monitoring and management of FGR to improve neonatal outcomes. This study evaluated differences and similarities in protocols of Dutch hospitals in the approach of (suspected) FGR in the context of the national guideline. Study design: FGR protocols were collected from Dutch hospitals between November 2019 and June 2020. Collected data were coded for further analysis and categorized in eight predetermined key domains of definition, preventive measures, testing, referral, monitoring strategies, interventions, mode of delivery and pathologic placenta examination. Results: 55 of 71 approached hospitals (78 %) responded to the request and 54 protocols (76 %) were obtained. Protocols used variable definitions of FGR, and management was mostly based on fetal biometry results in combination with Doppler results (n = 47, 87 %). In pregnancies with an abdominal circumference (AC) or an estimated fetal weight (EFW) <10th percentile with normal Doppler results, induction of labour was recommended ≥37 weeks (n = 1, 2 %), ≥38-40 weeks (n = 23, 43 %); ≥41 weeks (n = 1, 2 %) or not specified (n = 29, 54 %). In case of an umbilical artery (UA) Doppler pulsatility index >95th percentile, (preterm) labour induction was recommended in the majority of the protocols regardless of fetal size (≥36 weeks: n = 2, 4 %; ≥37 weeks: n = 41, 76 %, not stated: n = 11, 20 %). Conclusion: This study found practice variation in all predetermined domains of FGR protocols of Dutch hospitals, underscoring the complexity of the condition. The differences found in this study feed the research agenda that informs the process of improving obstetric care by better identification of the fetus at risk for consequences of FGR, improving evidence-based monitoring strategies to identify (imminent) fetal hypoxia, and more accurate timing of delivery.
KW - Cerebroplacental ratio
KW - Doppler velocimetry
KW - Fetal growth restriction
KW - Practice variation
KW - Small for gestational age
UR - http://www.scopus.com/inward/record.url?scp=85135390079&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ejogrb.2022.07.021
DO - https://doi.org/10.1016/j.ejogrb.2022.07.021
M3 - Review article
C2 - 35930814
SN - 0301-2115
VL - 276
SP - 191
EP - 198
JO - European Journal of Obstetrics and Gynecology and Reproductive Biology
JF - European Journal of Obstetrics and Gynecology and Reproductive Biology
ER -