Conclusions
1. Perinatal mortality and morbidity rates will not improve unless hospitals follow protocolized obstetric management.
2. Every pregnant woman needs to be proactively taught to monitor fetal movements and be aware of her due date.
3. ASHA workers need to be instructed to measure fundal height so that community identification of a small fetus for subsequent hospital antenatal visit can be identified,
4. Separate obstetric scanning clinics are better at triaging high-risk patients but need to communicate findings to patients more effectively
5. A black book follow-up approach needs to be instituted.
6. Referrals to higher centres need to be timely so that the patients do not get lost in the system.
7Public -private partnerships need to be encouraged so that skilled private healthcare workers are used to augment the care given by government doctors with no increase in financial liability to the Government.
We demonstrated that third-trimester ultrasound could identify nearly half of the fetuses that were at increased risk of perinatal mortality and morbidity. Third-trimester scanning needs to be offered given the high prevalence of small fetuses in our population .Current professional society obstetric guidelines for fetal monitoring, the timing of induction of labour, and better intrapartum management, along with strong patient awareness programmes will significantly improve outcomes.
Acknowledgements
Dr Amita Saxena, Dr Rachna Jain , Dr Naveen ,Sister Chinggouman and all the obstetric and neonatal staff of the study hospital for their unstinting cooperation in facilitating this study.
The clinical fellows of Apollo Centre for Fetal Medicine Dr Saloni Arora ,Dr Ayesha Ahmad , Dr Aanchal Sablok ,Dr Nilesh Mhaske and Dr Keerthana Anand as well as the senior staff who contributed in data collection.
The study was supported by GE Healthcare (Zipf, Austria) by providing the Voluson S8 ultrasound device and probes for ultrasound examinations during the study period and coordinated by Dr Laura S. Schultz and her team
Astraia GmbH donated the use of the obstetric database for the study period and Mr Roland Denk and Mr Rakesh Rai gave their continuous technical support.
Dr Nirmala Agarwal President ,All India Royal College Of Obstetricians and Gynaecologists -North Zone India who through the organisation donated a computer ,printer and peripherals for the study.
Fetal Medicine Foundation India who donated computer and peripherals for the study