Variation in the definition of intrauterine growth restriction in routine antenatal care: a physician survey among gynecologists in Northwest Germany.

OBJECTIVE: To assess how intrauterine growth restriction (IUGR) is defined by gynecologists in routine practice. MATERIALS AND METHODS: We surveyed primary care gynecologists in Bremen and Lower Saxony, Northwest Germany, between January and July 2014. Descriptive statistics were used to analyze the data; consensus was considered as 90% agreement among the respondents. Multiple logistic regression models were performed for the associations between respondents' background characteristics and choice of the small for gestational age (SGA) cutoff values. RESULTS: Overall, 185 primary care gynecologists participated in the survey. Consensus was only observed in two items: (1) an accurate determination of gestational age (91%) and (2) repeated measurement of the abdominal circumference (91%). Umbilical artery Doppler (76%) and repeated ultrasonography (76%) were the most frequently used methods to confirm suspected IUGR diagnoses, but different responses prevailed. Notably, only 46% of the respondents opted for the 10th percentile of estimated fetal weight as a cutoff for SGA classification, which is the internationally recommended value. CONCLUSIONS: The results of this survey indicate considerable practice variation regarding detection and management of IUGR pregnancies. There is a need for better agreement in terminology and definition of core aspects of IUGR in antenatal care.

Care-Related and Maternal Risk Factors Associated with the Antenatal Nondetection of Intrauterine Growth Restriction: A Case-Control Study from Bremen, Germany.

Objective. To identify care-related and maternal risk factors for the antenatal nondetection of IUGR. Methods. In this hospital-based case-control study we compared antenatally undetected IUGR neonates (cases) to detected IUGR neonates (controls). Data were collected using newborn documentation sheets and standardized personal interviews with the mothers. We calculated antenatal detection rates and used uni- and multivariable logistic regression models to assess the association of antenatal nondetection of IUGR and maternal and care-related factors. Results. A total of 161 neonates from three hospitals were included in the study. Suboptimal fetal growth was identified antenatally in n = 77 pregnancies while in n = 84 it was not detected antenatally (antenatal detection rate: 47.8%). Severity of IUGR, maternal complications, and a Doppler examination during the course of pregnancy were associated with IUGR detection. We did not find statistically significant differences regarding parental socioeconomic status and maternal migration background. Conclusions. In our study, about half of all pregnancies affected by suboptimal growth remained undetected. Future in-depth studies with larger study populations should further examine factors that could increase antenatal detection rates for IUGR.

Care-related factors associated with antepartal diagnosis of intrauterine growth restriction: a case-control study.

BACKGROUND: Antenatal care is of core importance for maternal and child health and is therefore a central aspect of mother and child health care. One of the main goals of effective screening in antenatal care is the detection of suboptimal fetal growth. However, the sensitivity of antenatal diagnostic of suboptimal fetal growth (i.e. intrauterine growth restriction; IUGR) through clinical routine fetal ultrasonography has been observed to be low. A study conducted in Germany found that only 30% of IUGR cases and 40% of congenital malformations were diagnosed antenatally. Reasons for this low detection rate remain unclear. METHODS/DESIGN: In the first of two study components, all mothers who delivered or will deliver a small for gestational age (SGA) newborn in one of three hospitals in Bremen (Germany) during recruitment phase are eligible for inclusion in a hospital based case-control study. Cases are defined as neonates with an IUGR that was not detected antenatally, while controls are defined as neonates whose IUGR was identified or at least suspected antenatally. Data collection instruments include a newborn documentation sheet, a standardized, computer-assisted personal interview with mothers, and a copy of pregnancy record books. The second component is a survey among all private practice-based gynecologists in the federal states of Bremen and Lower Saxony. The aim of this survey was to obtain detailed information e.g. on quality of ultrasonography equipment and examiner's ultrasonography experience and qualification level. DISCUSSION: To our knowledge, this is one of the few German studies explicitly addressing care-related as well as maternal-related factors influencing the (non-) detection of IUGR by conducting comprehensive interviews with mothers and private practice-based gynecologists. Over the last 15 years there have been substantial technological advances in ultrasonography equipment in gynecological practices; hence there is the need to evaluate whether the detection rates of IUGR in Germany are still as low as previously reported in the late 1990ies. Our study results will contribute to a better understanding of core risk factors for low early detection rates of intrauterine growth restrictions and may support quality development in this important health care sector.