Review of few obstetric management protocols
Firstly it was noted that once FGR was identified, only 28.57% (36/126) were delivered by 37.6 weeks. Another 22.2% were delivered post-dates( Table S5 shows Gestational Age at delivery of FGR cohort )
Secondly, there were 90/124 (72.58%)women who had an umbilical artery PI more than 95th centile and were undelivered beyond 37.6 weeks Out of these 25/37(67.57%) had EFW ≤ 3rdcentile and 20/28 (71.43%)had EFW between 3rd to ≤ 10th centile. Nearly 15% in all groups were post-dates (Table S6)
Thirdly, we identified 31 fetuses with malpresentation (breech). In primigravida women with breech presentation, over(7/26) 30% had either vaginal births or emergency C-sections beyond 39 weeks. On follow-up telephonic enquiry, it was found that many of these patients had not understood the importance of follow up.
There were three cases identified antenatally with structural abnormalities (congenital diaphragmatic hernia, ventricular septal defect, tracheoesophageal fistula) while one heart defect was found postnatally.
We can extrapolate that similar findings would have been seen in the standard care group which may have also contributed to the high perinatal mortality seen in that group.