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Definition and management of fetal growth restriction: a survey of contemporary attitudes.

Eur J Obstet Gynecol Reprod Biol. 2014 Mar;174:41-5. doi: 10.1016/j.ejogrb.2013.11.022. Epub 2013 Dec 5.

Unterscheider J1, Daly S2, Geary MP3, Kennelly MM4, McAuliffe FM5, O’Donoghue K6, Hunter A7, Morrison JJ8, Burke G9, Dicker P10, Tully EC10, Malone FD10.
1Royal College of Surgeons in Ireland, Dublin, Ireland. Electronic address: juliaunterscheider@rcsi.ie.2Coombe Women and Infants University Hospital, Dublin, Ireland.3Rotunda Hospital, Dublin, Ireland.4UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland.5UCD School of Medicine and Medical Science, National Maternity Hospital, Dublin, Ireland.6University College Cork, Cork University Maternity Hospital, Cork, Ireland.7Royal Jubilee Maternity Hospital, Belfast, Ireland.8National University of Ireland, Galway, Ireland.9Mid-Western Regional Maternity Hospital, Limerick, Ireland.10Royal College of Surgeons in Ireland, Dublin, Ireland.
Eur J Obstet Gynecol Reprod Biol
ABSTRACT
OBJECTIVE: To evaluate opinions among Irish obstetricians and obstetric trainees regarding the optimal definition, assessment and management of pregnancies affected by intrauterine growth restriction (IUGR).STUDY DESIGN: An anonymous, structured, web-based survey that comprised 14 questions was sent to 200 obstetricians and obstetric trainees in Ireland.RESULTS: Of the 113 participants (57% response rate), the majority (50%) were consultants, with over 10 years’ clinical experience (46%), who worked in large maternity units (58%) with neonatal units providing care for preterm IUGR fetuses (94%). Eighty-three clinicians (74%) agreed that an estimated fetal weight (EFW) below the 10th centile constitutes small-for-gestational age (SGA). The majority (n=93; 82%) would deliver the SGA fetus between 37(+0) and 39(+6) weeks gestation. In total, the survey yielded 30 different IUGR definitions; the top three definitions were (i) an EFW below the 5th centile (n=18; 16%), (ii) an EFW below the 10th centile with oligohydramnios and abnormal umbilical artery (UA) Doppler (n=16; 14%), and (iii) an EFW below the 10th centile (n=12; 11%). In the evaluation of the preterm IUGR fetus with abnormal UA Doppler, the assessment of amniotic fluid volume, middle cerebral artery, ductus venosus, cardiotocograph (CTG) and biophysical profiling was performed in 74%, 60%, 60%, 54% and 52% respectively. The majority of clinicians applied three or more assessment modalities and 60% referred to a maternal-fetal medicine (MFM) subspecialist. Interestingly, even among MFM subspecialists there was no common consistent management approach. Most doctors (81%) would deliver the IUGR fetus for CTG abnormalities but MFM subspecialists more commonly deliver on the basis of absent end-diastolic flow in the UA alone (37% vs. 10%; p=0.006). Two-thirds of doctors (n=74) would implement customised growth charts if they became available for their population and over 80% thought that a national guideline on IUGR would be beneficial.CONCLUSION: The results of this survey confirm the inconsistencies surrounding the clinical management of IUGR pregnancies and highlight the need for standardisation of terminology and antenatal surveillance, implementation of fetal weight customisation and national guidance for Ireland.Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Full Text Source: Elsevier Science
PMID:24360357 | http://www.ncbi.nlm.nih.gov/pubmed/24360357

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