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