Introduction
An estimated 2.6 million third-trimester stillbirths occurred in 2015,
and almost all were in low and middle-income countries (LMIC )
1. Approximately 590,000 (22.7%) of these stillbirths
occurred in India, representing the most significant numbers of
stillbirths globally.2
While, a multiplicity of factors contribute to stillbirth, over half are
related to placental dysfunction, many of these associated with impaired
fetal growth3This suggests that antenatal detection of
fetal growth restriction (FGR), should lead to an overall decrease in
stillbirths with the majority being preventable. 4-6
Not only does India have the most significant number of small for
gestational age (SGA) births of any country, at 12.8 million, but the
overall percentage of SGA within the country is also extremely high
(46.9%)
7
Universal third trimester ultrasound has been shown to triple the
detection rate of SGA infant 8
Currently, the Indian government only mandates a mid-trimester
ultrasound 9
We proposed that a third-trimester ultrasound may better identify the
growth-restricted fetus.
Our primary hypothesis was stillbirth, along with neonatal morbidity and
mortality will be lower in the cohort of women undergoing
third-trimester ultrasound in a specialized obstetric scanning clinic
when compared to women undergoing standard antenatal care in the same
hospital. The health statistics for the latter will be derived from data
submitted to the Ministry of Health and Family Welfare of India,10during the same study period.
Secondary analysis would be performed on all perinatal deaths in the
study group to ascertain preventable causes. We hoped to achieve the
target set by the India Newborn Action Plan (INAP), 11the first national stillbirth-prevention target set at achieving
<10 stillbirths per 1,000 births by 2030