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Why we succeed and fail in detecting fetal growth restriction: A population-based study

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@article{94d7e2d84085493b9997dd1c0d2ba780,
title = "Why we succeed and fail in detecting fetal growth restriction: A population-based study",
abstract = "Introduction: The objective of this study was to explore the association between detection of fetal growth restriction and maternal-, healthcare provider- and organizational factors. Material and methods: A historical, observational, multicentre study. All women who gave birth to a child with a birthweight <2.3rd centile from 1 September 2012 to 31 August 2015 in Zealand, Denmark, were included. The population was identified through the Danish Fetal Medicine Database. Medical charts were reviewed to obtain data regarding maternal characteristics and information on the healthcare professionals. Date of authorization for the midwives and obstetricians involved was extracted from the Danish Health Authorization Registry. Multivariable Cox regression models were used to identify predictors of antenatal detection of fetal growth restriction, and analyses were adjusted for hospital, body mass index, parity, the presence of at least one risk factor and experience of the first midwife, number of midwife visits, number of visits to a doctor, the experience of the consultant midwife or the educational level of the doctor, the number of scans and gaps in continuity of midwife-care. Antenatal detection was defined as an ultrasound estimated fetal weight <2.3rd centile (corresponding to −2 standard deviations) prior to delivery. Results: Among 78 544 pregnancies, 3069 (3.9%) had a fetal growth restriction. Detection occurred in 31% of fetal growth-restricted pregnancies. Clinical experience (defined as years since graduation) of the first consultation midwife was positively associated with detection, with a hazard ratio [HR] of 1.15, 95% confidence interval [CI] 1.03-1.28), for every 10 years of additional experience. The hazard of detection increased with the number of midwife consultations (HR 1.15, 95% CI 1.05-1.26) and with multiparity (HR 1.28, 95% CI 1.03-1.58). After adjusting for all covariates, an unexplained difference between hospitals (P =.01) remained. Conclusions: The low-risk nullipara may constitute an overlooked group of women at increased risk of antenatal non-detection of fetal growth restriction. Being screened by experienced midwives during early pregnancy and having access to multiple midwife consultations may improve future diagnosis.",
keywords = "Adult, Cohort Studies, Denmark/epidemiology, Female, Fetal Growth Retardation/diagnosis, Hospitals, Humans, Midwifery, Pregnancy, Prenatal Care/statistics & numerical data, Prenatal Diagnosis/statistics & numerical data, Proportional Hazards Models",
author = "Andreasen, {Lisbeth Anita} and Ann Tabor and N{\o}rgaard, {Lone Nikoline} and Taks{\o}e-Vester, {Caroline Amalie} and Lone Krebs and J{\o}rgensen, {Finn Stener} and Jepsen, {Ida Engberg} and Heidi Sharif and Helle Zingenberg and Susanne Rosth{\o}j and S{\o}rensen, {Anne Lyngholm} and Tolsgaard, {Martin Gr{\o}nnebaek}",
note = "{\textcopyright} 2020 Nordic Federation of Societies of Obstetrics and Gynecology.",
year = "2021",
month = may,
doi = "10.1111/aogs.14048",
language = "English",
volume = "100",
pages = "893--899",
journal = "Acta Obstetricia et Gynecologica Scandinavica",
issn = "0001-6349",
publisher = "Informa Healthcare",
number = "5",

}

RIS

TY - JOUR

T1 - Why we succeed and fail in detecting fetal growth restriction

T2 - A population-based study

AU - Andreasen, Lisbeth Anita

AU - Tabor, Ann

AU - Nørgaard, Lone Nikoline

AU - Taksøe-Vester, Caroline Amalie

AU - Krebs, Lone

AU - Jørgensen, Finn Stener

AU - Jepsen, Ida Engberg

AU - Sharif, Heidi

AU - Zingenberg, Helle

AU - Rosthøj, Susanne

AU - Sørensen, Anne Lyngholm

AU - Tolsgaard, Martin Grønnebaek

N1 - © 2020 Nordic Federation of Societies of Obstetrics and Gynecology.

PY - 2021/5

Y1 - 2021/5

N2 - Introduction: The objective of this study was to explore the association between detection of fetal growth restriction and maternal-, healthcare provider- and organizational factors. Material and methods: A historical, observational, multicentre study. All women who gave birth to a child with a birthweight <2.3rd centile from 1 September 2012 to 31 August 2015 in Zealand, Denmark, were included. The population was identified through the Danish Fetal Medicine Database. Medical charts were reviewed to obtain data regarding maternal characteristics and information on the healthcare professionals. Date of authorization for the midwives and obstetricians involved was extracted from the Danish Health Authorization Registry. Multivariable Cox regression models were used to identify predictors of antenatal detection of fetal growth restriction, and analyses were adjusted for hospital, body mass index, parity, the presence of at least one risk factor and experience of the first midwife, number of midwife visits, number of visits to a doctor, the experience of the consultant midwife or the educational level of the doctor, the number of scans and gaps in continuity of midwife-care. Antenatal detection was defined as an ultrasound estimated fetal weight <2.3rd centile (corresponding to −2 standard deviations) prior to delivery. Results: Among 78 544 pregnancies, 3069 (3.9%) had a fetal growth restriction. Detection occurred in 31% of fetal growth-restricted pregnancies. Clinical experience (defined as years since graduation) of the first consultation midwife was positively associated with detection, with a hazard ratio [HR] of 1.15, 95% confidence interval [CI] 1.03-1.28), for every 10 years of additional experience. The hazard of detection increased with the number of midwife consultations (HR 1.15, 95% CI 1.05-1.26) and with multiparity (HR 1.28, 95% CI 1.03-1.58). After adjusting for all covariates, an unexplained difference between hospitals (P =.01) remained. Conclusions: The low-risk nullipara may constitute an overlooked group of women at increased risk of antenatal non-detection of fetal growth restriction. Being screened by experienced midwives during early pregnancy and having access to multiple midwife consultations may improve future diagnosis.

AB - Introduction: The objective of this study was to explore the association between detection of fetal growth restriction and maternal-, healthcare provider- and organizational factors. Material and methods: A historical, observational, multicentre study. All women who gave birth to a child with a birthweight <2.3rd centile from 1 September 2012 to 31 August 2015 in Zealand, Denmark, were included. The population was identified through the Danish Fetal Medicine Database. Medical charts were reviewed to obtain data regarding maternal characteristics and information on the healthcare professionals. Date of authorization for the midwives and obstetricians involved was extracted from the Danish Health Authorization Registry. Multivariable Cox regression models were used to identify predictors of antenatal detection of fetal growth restriction, and analyses were adjusted for hospital, body mass index, parity, the presence of at least one risk factor and experience of the first midwife, number of midwife visits, number of visits to a doctor, the experience of the consultant midwife or the educational level of the doctor, the number of scans and gaps in continuity of midwife-care. Antenatal detection was defined as an ultrasound estimated fetal weight <2.3rd centile (corresponding to −2 standard deviations) prior to delivery. Results: Among 78 544 pregnancies, 3069 (3.9%) had a fetal growth restriction. Detection occurred in 31% of fetal growth-restricted pregnancies. Clinical experience (defined as years since graduation) of the first consultation midwife was positively associated with detection, with a hazard ratio [HR] of 1.15, 95% confidence interval [CI] 1.03-1.28), for every 10 years of additional experience. The hazard of detection increased with the number of midwife consultations (HR 1.15, 95% CI 1.05-1.26) and with multiparity (HR 1.28, 95% CI 1.03-1.58). After adjusting for all covariates, an unexplained difference between hospitals (P =.01) remained. Conclusions: The low-risk nullipara may constitute an overlooked group of women at increased risk of antenatal non-detection of fetal growth restriction. Being screened by experienced midwives during early pregnancy and having access to multiple midwife consultations may improve future diagnosis.

KW - Adult

KW - Cohort Studies

KW - Denmark/epidemiology

KW - Female

KW - Fetal Growth Retardation/diagnosis

KW - Hospitals

KW - Humans

KW - Midwifery

KW - Pregnancy

KW - Prenatal Care/statistics & numerical data

KW - Prenatal Diagnosis/statistics & numerical data

KW - Proportional Hazards Models

UR - http://www.scopus.com/inward/record.url?scp=85099174728&partnerID=8YFLogxK

U2 - 10.1111/aogs.14048

DO - 10.1111/aogs.14048

M3 - Journal article

C2 - 33220065

VL - 100

SP - 893

EP - 899

JO - Acta Obstetricia et Gynecologica Scandinavica

JF - Acta Obstetricia et Gynecologica Scandinavica

SN - 0001-6349

IS - 5

ER -

ID: 61288701