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The impact of a universal late third-trimester scan for fetal growth restriction on perinatal outcomes in term singleton births: a prospective cohort study
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  • Adeniyi Aderoba,
  • Christos Ioannou,
  • Jennifer Kurinczuk,
  • Angelo Cavallaro,
  • Maria Quigley,
  • Lawrence Impey,
  • OxGRIP Group
Adeniyi Aderoba
University of Oxford

Corresponding Author:[email protected]

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Christos Ioannou
Oxford University Hospitals NHS Trust
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Jennifer Kurinczuk
University of Oxford
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Angelo Cavallaro
Oxford University Hospitals NHS Trust
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Maria Quigley
University of Oxford
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Lawrence Impey
Oxford University Hospitals NHS Trust
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OxGRIP Group
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Objective To investigate perinatal mortality, morbidity and obstetric intervention after introducing universal third-trimester ultrasound scan for growth restriction. Design Prospective cohort study Setting Oxfordshire (OUH), UK Population Women with a non-anomalous singleton pregnancy undergoing pregnancy care and term delivery at OUH with an estimated-date-of-birth between 01/Jan/2014 and 30/Sept/2019. Methods Universal ultrasound for fetal growth restriction between 35+0 and 36+6 weeks was introduced in 2016. The outcomes of the next 18631 eligible term pregnancies were compared, using logistic regression, with the previous 18636 who had clinically-indicated ultrasounds only. ‘Screen positives’ for growth restriction were managed according to a pre-determined protocol. Main Outcome Measures Extended perinatal mortality, a composite of mortality or encephalopathy Grade II-III, and expedited birth. Other outcomes included composite adverse outcomes used elsewhere, detection of birthweight (<10th centile) and birth <39+0 weeks. Results Extended perinatal deaths decreased from 1.7/1000 to 1.2/1000 births (aOR: 0.73; 0.43 -1.25); mortality or severe morbidity decreased from 2.9/1000 to 1.9/1000 births (OR: 0.67; 0.44-1.03). Expedited births increased from 35.2% to 37.7% (OR: 1.08; 1.04 – 1.14). Birth prior to 39+0 weeks fell 10.5% (OR 0.89: 0.85 – 0.94). Birthweight (<10th centile) detection using fetal biometry alone was 31.4%, and rose to 40.5% if all abnormal scan parameters were used. Conclusion Introducing a universal ultrasound for growth restriction has limited impact on mortality and severe morbidity, but only small increases in intervention, and less early-term birth, are possible. The detection of birthweight (<10th c) improved where markers of growth restriction are used.
24 May 2022Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
30 May 2022Submission Checks Completed
30 May 2022Assigned to Editor
04 Jun 2022Reviewer(s) Assigned
19 Jun 2022Review(s) Completed, Editorial Evaluation Pending
20 Jul 2022Editorial Decision: Revise Major
28 Sep 20221st Revision Received
30 Sep 2022Assigned to Editor
30 Sep 2022Submission Checks Completed
30 Sep 2022Review(s) Completed, Editorial Evaluation Pending
26 Oct 2022Editorial Decision: Revise Minor
02 Nov 20222nd Revision Received
07 Nov 2022Submission Checks Completed
07 Nov 2022Assigned to Editor
07 Nov 2022Review(s) Completed, Editorial Evaluation Pending
30 Dec 2022Editorial Decision: Accept