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