Fetal Growth Complications, Induction of Labor Affected Fetus / Newborn, Obstetric Complication, Ultrasound
Conditions
Brief summary
Best management of suspected large for gestational age (LGA) fetuses is unclear. In some hospitals women with an LGA fetus by customised growth charts are are offered earlier induction. This study aimed to examine scan accuracy for this group and the outcome with intervention.
Detailed description
This is a retrospective cohort study of pregnant women taken from 3 groups; women with a suspected LGA fetus (LGA), women with diabetes (DM) and a control group of women that underwent induction of labour at or after 40 weeks. Scan accuracy using GROW and WHO charts in the LGA and DM cohorts was assessed using ROC curves and outcomes between the cohorts was compared.
Interventions
PROCEDUREInduction of labour
Induction of labour using amniotomy, vaginal prostaglandin administration and syntocinon in combination as per protocol.
Sponsors
Newcastle University
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Healthy volunteers
No
Inclusion criteria
* Induced labour of a singleton pregnancy at Northumbria Healthcare Foundation trust resulting in a delivery between 01/01/2018 and 31/12/2018. Inclusion in the LGA group means that the main indication for induction is recorded as suspected macrosomia. Inclusion in the Diabetic group means diabetes was pre-existing or arose in pregnancy, diagnosed by oral glucose tolerance testing from 24-30 weeks or by home blood glucose monitoring with standard thresholds as per NICE ng3. Induction had to be undertaken with diabetes as the (co)indication. Inclusion criteria for the control group was induction of labour at or after 280 days gestation
Exclusion criteria
Previous caesarean section Multiple pregnancy Fetal concerns pre-induction: abnormal antenatal trace or abnormal doppler flow studies on antenatal ultrasound * Cases of induction for suspected LGA are to be excluded if there is a co-indication of obstetric cholestasis, hypertensive disorder or diabetes.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Birthweight | through study completion, an average of 1 year | Neonatal weight as taken following delivery |
| Mode of delivery | through study completion, an average of 1 year | Caesarean section and assisted delivery rates |
| Shoulder dystocia rate | through study completion, an average of 1 year | Any clinically diagnosed cases of shoulder dystocia where the shoulders did not deliver with routine axial traction on the next contraction after the head was delivered. |
| Estimated blood loss | through study completion, an average of 1 year | Blood loss as estimated by the clinical team |
| Obstetric Anal Sphincter Injury | through study completion, an average of 1 year | Any tear involving the external anal sphincter and/or rectal mucosa |
| Admission to special care baby unit (SCBU) | through study completion, an average of 1 year | Admission of neonate to neonatal unit from labour ward |
| Epidural rate | through study completion, an average of 1 year | Use of epdiural analgesia intrapartum |
Other
| Measure | Time frame | Description |
|---|---|---|
| Birthweight centile as per customised chart | through study completion, an average of 1 year | Birthweight centile given birthweight and maternal characteristics as per perinatal institute |
| Birthweight centile as per WHO population chart | through study completion, an average of 1 year | Based on Kiserud T, Piaggio G, Carroli G, Widmer M, Carvalho J, et al. (2017) The World Health Organization Fetal Growth Charts: A Multinational Longitudinal Study of Ultrasound Biometric Measurements and Estimated Fetal Weight. PLOS Medicine 14(1): e1002220. https://doi.org/10.1371/journal.pmed.1002220 |
| Scan error as a percentage of estimated fetal weight | through study completion, an average of 1 year | Difference between birthweight and what it was expected to be based on estimated weight (using perinatal institutes calculator) at scan, given as a percentage of that estimated weight |
| Prediction of Customised growth chart birthweight >90th centile by estimated weight on scan | through study completion, an average of 1 year | As above |
| Prediction of birthweight >4kg based on projected weight at time of delivery from scan estimated weight | through study completion, an average of 1 year | As above |
| Prediction of WHO birthweight >90th centile by scan estimated weight centile on WHO chart | through study completion, an average of 1 year | As above |
Countries
United Kingdom
Outcome results
None listed