RESULTS:
Maternal Characteristics : The age of the women enrolled in the study ranged from 18 years to 42 years, with mean age of 25.5 years ±3.7 years. Majority (81.4%) of women were below 30 years of age, and 0.6% were >35years. The average height of the subjects was 154.2±3.7 cm, with a minimum of 142 cm and a maximum of 166cm. Only 0.6% subjects were shorter than 145 cm.
Among the study subjects, 65.2% were multigravidae and, 34.8% were primigravida. There was an equal distribution of nulliparous (49.6%) and multiparous women (50.4%). Majority (71.4%) of the women had no prior history of abortions, 28.6% had at least one abortion of these 1.8% had history of 3 or more abortions.
According to Asian BMI cut off, 64.8% of women had a normal BMI, 28.6% were overweight, 6% were pre-obese and 0.6% were underweight. The average BMI was 22.4± 1.53 kg/m2 (ranging from 17.7 kg/m2 to 29.2 kg/m2). As per Indian Council of Medical Research (ICMR) classification of anaemia in pregnancy, 52.2% of women were anaemic, of which 41.8% had mild anaemia and 10.4% had moderate anaemia. Majority 89.60% (448 out of 500) had a normal vaginal delivery. 10.4% (52 out of 500) women had caesarean birth.
Fetal Outcome : Of the 500 new-borns, 66 (13.2%) were small for gestational age as defined by birthweight less than 10th centile on the International Foetal Growth Standards Estimated Foetal Weight Chart and 434 (86.8%) were appropriate for gestational age (AGA).
The mean birthweight of the new-borns was 2.78±0.30 kg, ranging from 1.72 kg to 4.0 kg. Of the women clinically suspected to have small for gestational age foetus, 78.8% (52 out of 66) had a birthweight less than 2.5 kg, while 2.8% (12 out of 434) women assessed to have normal foetal growth antenatally gave birth to a small for gestational age neonate (less than 2.5 kg). Of the SGA neonates 9.1% (6 out of 66) were born preterm, compared to 5.3% (23 out of 434) of AGA neonates.
In the study population, 57.6% of small for gestational age new-borns were females, compared to 42.4% males. Perinatal complications were seen in 15.2% of small for gestational age neonates compared to 3.7% of AGA neonates (Fig. 1). A higher proportion of SGA new-borns (12.1%) required NICU admission as compared to 1.2% AGA neonates. The difference was statistically significant (p=0.001).
Of the total study population, 66/500 (13.3%) delivered new-borns with birthweight below 10th centile for the gestational age using International Foetal Growth Standards Estimated Foetal
Weight Charts.
On clinical examination, 52 (10.4%) women were suspected to have a small for gestational age fetus by fundal height palpation compared to 57 (11.4%) women by SFH measurement as charted on International Symphysis Fundal Height Standards.
Of the 57 women suspected with small for gestational age fetuses based on SFH measurement charted on standard charts, SGA was correctly detected in 96.5% (55/57) as compared to 88.5% (46/52) among the 52 women suspected to have SGA by conventional FH palpation. SGA was over-diagnosed in 3.5% (2/57) by SFH measurement in comparison to 11.5% (6/52) by the conventional method of fundal height palpation. In women in whom normal growth was assessed by SFH measurement on standard charts, 97.5% (432/443) delivered AGA new-borns compared to 95.5% (428/448) with fundal height palpation method. SGA was missed in only 2.4% (11/443) of women by SFH measurement as compared to 4.5% (20/448) by fundal height palpation.
Significance measured by Chi-Square test gives a p-value of <0.001, indicating test results to be significant.