An Audit of Pregnancies complicated by Intrauterine Growth Restriction at Lautoka Hospital

ABSTRACT

Introduction@#IUGR is an obstetrical complication that is difficult to identify in order to allow intervention to lessen morbidity and mortality. The Lancet series on stillbirths highlighted the causes of stillbirths globally, identifying IUGR as one of the five major causes. IUGR has accounted for almost a third of all still births at Lautoka Hospital over the past three years. The aim of this study was to audit all pregnancies complicated by IUGR, the contributing risk factors and their outcomes at Lautoka Hospital from 1st January to 31st December 2016. @*Aim@#To conduct a retrospective audit of pregnancies complicated by IUGR at Lautoka Hospital from 1st January 2016 to 31st December 2016.@*Method@#This is a retrospective descriptive audit using clinical notes, conducted on 170 women diagnosed with IUGR in 2016. @*Results@#There were 4,131 deliveries during the study period; 191 patients of whom were diagnosed with IUGR of which 170 folders were retrieved. The Incidence rate of those diagnosed with IUGR during this period was 4.3%. Seventy percent of women with IUGR had low to normal Body Mass Index (BMI) and booked in the late second to third trimester. The risk of developing IUGR was significantly increased in Fijians of Indian Descent (FID) (RR 4, CI 2.9-5.3, p-value <0.0001); in primigravida (RR 4.1, CI 3.5 – 4.7, p-value <0.0001); and those with previously Low Birth Weight baby (LBW) (< 2500g) (RR 2.3, CI 1.67 – 3.26, p-value <0.0001). Anaemia or hypertension diagnosed during pregnancy significantly increased the risk of developing IUGR (RR 1.7, CI 1.3-2.40, p-value 0.0002) and (RR 2.6, CI 1.75 – 4.05, p-value <0.0001) respectively. Women with IUGR have a 6 times higher chance of having a Still Birth (SB) (RR 6.1, CI 3.78-9.92, p-value <0.0001); higher risk of Induction of Labour (RR 4.2, CI 3.65-5.64, p-value <0.0001) and caesarean section delivery (RR 2.1, CI 1.54-2.85, p-value <0.0001). Seventy eight percent of still births were delivered beyond 37 weeks, a possible delay, which could have been avoided potentially improving the SB rate. SB risk was significantly higher in those diagnosed at or > 37 weeks gestation compared to those with an earlier diagnosis (RR 1.61 95% CI 1.11 – 2.35, p value 0.05). @*Conclusion@#IUGR contributes significantly to still births. There were delays in diagnosis and appropriate surveillance to allow timely delivery at Lautoka Hospital, which could have reduced the still birth rate.