Why we succeed and fail in detecting fetal growth restriction: A population‐based study
Introduction The objective of this study was to explore the association between detection of fetal growth restriction and maternal‐, healthcare provider‐ and organizational factors. Material and methods A historical, observational, multicentre study. All women who gave birth to a child with a birthw...
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| Veröffentlicht in: | Acta obstetricia et gynecologica Scandinavica 2021-05, Vol.100 (5), p.893-899 |
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| creator | Andreasen, Lisbeth A. Tabor, Ann Nørgaard, Lone Nikoline Taksøe‐Vester, Caroline A. Krebs, Lone Jørgensen, Finn S. Jepsen, Ida E. Sharif, Heidi Zingenberg, Helle Rosthøj, Susanne Sørensen, Anne L. Tolsgaard, Martin Grønnebæk |
| description | Introduction
The objective of this study was to explore the association between detection of fetal growth restriction and maternal‐, healthcare provider‐ and organizational factors.
Material and methods
A historical, observational, multicentre study. All women who gave birth to a child with a birthweight |
| doi_str_mv | 10.1111/aogs.14048 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2463103135</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2463103135</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3938-fb0881e0bad5b5d97719c305720e7b3eea756169c8f5afd418a0fcf53b80dbf83</originalsourceid><addsrcrecordid>eNp9kM1K9DAUhoN8ouPPxguQwLcRoXrSNG3qbhD_QHChIq5CmpyMlU47Ji3D7LwEr9ErMeOoCxeezeHlPDwcXkL2GByxOMe6m4QjlkEm18iI5QAJZCz9R0YAwJKcZ-Um2QrhOaa0yOQG2eQ8TQFyMSKPD08LOkcaBmMQLdWtpU7XDa1barFH09fthDrsdUMnvpv3T9Rj6H0dD117Qsd01s2GRi_T--tbpUOUhH6wix2y7nQTcPdrb5P787O708vk-ubi6nR8nRhecpm4CqRkCJW2ohK2LApWGg6iSAGLiiPqQuQsL410QjubManBGSd4JcFWTvJtcrDyznz3MsTf1LQOBptGt9gNQaVZzhlwxkVE__9Cn7vBt_E7lQqWsTzNRRGpwxVlfBeCR6dmvp5qv1AM1LJwtSxcfRYe4f0v5VBN0f6g3w1HgK2Aed3g4g-VGt9c3K6kH72Hi5w</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2514162657</pqid></control><display><type>article</type><title>Why we succeed and fail in detecting fetal growth restriction: A population‐based study</title><source>Wiley Online Library Journals Frontfile Complete</source><creator>Andreasen, Lisbeth A. ; Tabor, Ann ; Nørgaard, Lone Nikoline ; Taksøe‐Vester, Caroline A. ; Krebs, Lone ; Jørgensen, Finn S. ; Jepsen, Ida E. ; Sharif, Heidi ; Zingenberg, Helle ; Rosthøj, Susanne ; Sørensen, Anne L. ; Tolsgaard, Martin Grønnebæk</creator><creatorcontrib>Andreasen, Lisbeth A. ; Tabor, Ann ; Nørgaard, Lone Nikoline ; Taksøe‐Vester, Caroline A. ; Krebs, Lone ; Jørgensen, Finn S. ; Jepsen, Ida E. ; Sharif, Heidi ; Zingenberg, Helle ; Rosthøj, Susanne ; Sørensen, Anne L. ; Tolsgaard, Martin Grønnebæk</creatorcontrib><description>Introduction
The objective of this study was to explore the association between detection of fetal growth restriction and maternal‐, healthcare provider‐ and organizational factors.
Material and methods
A historical, observational, multicentre study. All women who gave birth to a child with a birthweight <2.3rd centile from 1 September 2012 to 31 August 2015 in Zealand, Denmark, were included. The population was identified through the Danish Fetal Medicine Database. Medical charts were reviewed to obtain data regarding maternal characteristics and information on the healthcare professionals. Date of authorization for the midwives and obstetricians involved was extracted from the Danish Health Authorization Registry. Multivariable Cox regression models were used to identify predictors of antenatal detection of fetal growth restriction, and analyses were adjusted for hospital, body mass index, parity, the presence of at least one risk factor and experience of the first midwife, number of midwife visits, number of visits to a doctor, the experience of the consultant midwife or the educational level of the doctor, the number of scans and gaps in continuity of midwife‐care. Antenatal detection was defined as an ultrasound estimated fetal weight <2.3rd centile (corresponding to −2 standard deviations) prior to delivery.
Results
Among 78 544 pregnancies, 3069 (3.9%) had a fetal growth restriction. Detection occurred in 31% of fetal growth‐restricted pregnancies. Clinical experience (defined as years since graduation) of the first consultation midwife was positively associated with detection, with a hazard ratio [HR] of 1.15, 95% confidence interval [CI] 1.03‐1.28), for every 10 years of additional experience. The hazard of detection increased with the number of midwife consultations (HR 1.15, 95% CI 1.05‐1.26) and with multiparity (HR 1.28, 95% CI 1.03‐1.58). After adjusting for all covariates, an unexplained difference between hospitals (P = .01) remained.
Conclusions
The low‐risk nullipara may constitute an overlooked group of women at increased risk of antenatal non‐detection of fetal growth restriction. Being screened by experienced midwives during early pregnancy and having access to multiple midwife consultations may improve future diagnosis.</description><identifier>ISSN: 0001-6349</identifier><identifier>EISSN: 1600-0412</identifier><identifier>DOI: 10.1111/aogs.14048</identifier><identifier>PMID: 33220065</identifier><language>eng</language><publisher>United States: John Wiley & Sons, Inc</publisher><subject>detection ; fetal growth restriction ; Fetuses ; Growth disorders ; Health risks ; Medical diagnosis ; Medical screening ; Midwifery ; Population-based studies ; Pregnancy ; Prenatal care ; Prenatal development ; small for gestation age</subject><ispartof>Acta obstetricia et gynecologica Scandinavica, 2021-05, Vol.100 (5), p.893-899</ispartof><rights>2020 Nordic Federation of Societies of Obstetrics and Gynecology</rights><rights>2020 Nordic Federation of Societies of Obstetrics and Gynecology.</rights><rights>Copyright © 2021 Acta Obstetricia et Gynecologica Scandinavica</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3938-fb0881e0bad5b5d97719c305720e7b3eea756169c8f5afd418a0fcf53b80dbf83</citedby><cites>FETCH-LOGICAL-c3938-fb0881e0bad5b5d97719c305720e7b3eea756169c8f5afd418a0fcf53b80dbf83</cites><orcidid>0000-0001-7831-2555 ; 0000-0002-5634-2830</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Faogs.14048$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Faogs.14048$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33220065$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Andreasen, Lisbeth A.</creatorcontrib><creatorcontrib>Tabor, Ann</creatorcontrib><creatorcontrib>Nørgaard, Lone Nikoline</creatorcontrib><creatorcontrib>Taksøe‐Vester, Caroline A.</creatorcontrib><creatorcontrib>Krebs, Lone</creatorcontrib><creatorcontrib>Jørgensen, Finn S.</creatorcontrib><creatorcontrib>Jepsen, Ida E.</creatorcontrib><creatorcontrib>Sharif, Heidi</creatorcontrib><creatorcontrib>Zingenberg, Helle</creatorcontrib><creatorcontrib>Rosthøj, Susanne</creatorcontrib><creatorcontrib>Sørensen, Anne L.</creatorcontrib><creatorcontrib>Tolsgaard, Martin Grønnebæk</creatorcontrib><title>Why we succeed and fail in detecting fetal growth restriction: A population‐based study</title><title>Acta obstetricia et gynecologica Scandinavica</title><addtitle>Acta Obstet Gynecol Scand</addtitle><description>Introduction
The objective of this study was to explore the association between detection of fetal growth restriction and maternal‐, healthcare provider‐ and organizational factors.
Material and methods
A historical, observational, multicentre study. All women who gave birth to a child with a birthweight <2.3rd centile from 1 September 2012 to 31 August 2015 in Zealand, Denmark, were included. The population was identified through the Danish Fetal Medicine Database. Medical charts were reviewed to obtain data regarding maternal characteristics and information on the healthcare professionals. Date of authorization for the midwives and obstetricians involved was extracted from the Danish Health Authorization Registry. Multivariable Cox regression models were used to identify predictors of antenatal detection of fetal growth restriction, and analyses were adjusted for hospital, body mass index, parity, the presence of at least one risk factor and experience of the first midwife, number of midwife visits, number of visits to a doctor, the experience of the consultant midwife or the educational level of the doctor, the number of scans and gaps in continuity of midwife‐care. Antenatal detection was defined as an ultrasound estimated fetal weight <2.3rd centile (corresponding to −2 standard deviations) prior to delivery.
Results
Among 78 544 pregnancies, 3069 (3.9%) had a fetal growth restriction. Detection occurred in 31% of fetal growth‐restricted pregnancies. Clinical experience (defined as years since graduation) of the first consultation midwife was positively associated with detection, with a hazard ratio [HR] of 1.15, 95% confidence interval [CI] 1.03‐1.28), for every 10 years of additional experience. The hazard of detection increased with the number of midwife consultations (HR 1.15, 95% CI 1.05‐1.26) and with multiparity (HR 1.28, 95% CI 1.03‐1.58). After adjusting for all covariates, an unexplained difference between hospitals (P = .01) remained.
Conclusions
The low‐risk nullipara may constitute an overlooked group of women at increased risk of antenatal non‐detection of fetal growth restriction. Being screened by experienced midwives during early pregnancy and having access to multiple midwife consultations may improve future diagnosis.</description><subject>detection</subject><subject>fetal growth restriction</subject><subject>Fetuses</subject><subject>Growth disorders</subject><subject>Health risks</subject><subject>Medical diagnosis</subject><subject>Medical screening</subject><subject>Midwifery</subject><subject>Population-based studies</subject><subject>Pregnancy</subject><subject>Prenatal care</subject><subject>Prenatal development</subject><subject>small for gestation age</subject><issn>0001-6349</issn><issn>1600-0412</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kM1K9DAUhoN8ouPPxguQwLcRoXrSNG3qbhD_QHChIq5CmpyMlU47Ji3D7LwEr9ErMeOoCxeezeHlPDwcXkL2GByxOMe6m4QjlkEm18iI5QAJZCz9R0YAwJKcZ-Um2QrhOaa0yOQG2eQ8TQFyMSKPD08LOkcaBmMQLdWtpU7XDa1barFH09fthDrsdUMnvpv3T9Rj6H0dD117Qsd01s2GRi_T--tbpUOUhH6wix2y7nQTcPdrb5P787O708vk-ubi6nR8nRhecpm4CqRkCJW2ohK2LApWGg6iSAGLiiPqQuQsL410QjubManBGSd4JcFWTvJtcrDyznz3MsTf1LQOBptGt9gNQaVZzhlwxkVE__9Cn7vBt_E7lQqWsTzNRRGpwxVlfBeCR6dmvp5qv1AM1LJwtSxcfRYe4f0v5VBN0f6g3w1HgK2Aed3g4g-VGt9c3K6kH72Hi5w</recordid><startdate>202105</startdate><enddate>202105</enddate><creator>Andreasen, Lisbeth A.</creator><creator>Tabor, Ann</creator><creator>Nørgaard, Lone Nikoline</creator><creator>Taksøe‐Vester, Caroline A.</creator><creator>Krebs, Lone</creator><creator>Jørgensen, Finn S.</creator><creator>Jepsen, Ida E.</creator><creator>Sharif, Heidi</creator><creator>Zingenberg, Helle</creator><creator>Rosthøj, Susanne</creator><creator>Sørensen, Anne L.</creator><creator>Tolsgaard, Martin Grønnebæk</creator><general>John Wiley & Sons, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7831-2555</orcidid><orcidid>https://orcid.org/0000-0002-5634-2830</orcidid></search><sort><creationdate>202105</creationdate><title>Why we succeed and fail in detecting fetal growth restriction: A population‐based study</title><author>Andreasen, Lisbeth A. ; Tabor, Ann ; Nørgaard, Lone Nikoline ; Taksøe‐Vester, Caroline A. ; Krebs, Lone ; Jørgensen, Finn S. ; Jepsen, Ida E. ; Sharif, Heidi ; Zingenberg, Helle ; Rosthøj, Susanne ; Sørensen, Anne L. ; Tolsgaard, Martin Grønnebæk</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3938-fb0881e0bad5b5d97719c305720e7b3eea756169c8f5afd418a0fcf53b80dbf83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>detection</topic><topic>fetal growth restriction</topic><topic>Fetuses</topic><topic>Growth disorders</topic><topic>Health risks</topic><topic>Medical diagnosis</topic><topic>Medical screening</topic><topic>Midwifery</topic><topic>Population-based studies</topic><topic>Pregnancy</topic><topic>Prenatal care</topic><topic>Prenatal development</topic><topic>small for gestation age</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Andreasen, Lisbeth A.</creatorcontrib><creatorcontrib>Tabor, Ann</creatorcontrib><creatorcontrib>Nørgaard, Lone Nikoline</creatorcontrib><creatorcontrib>Taksøe‐Vester, Caroline A.</creatorcontrib><creatorcontrib>Krebs, Lone</creatorcontrib><creatorcontrib>Jørgensen, Finn S.</creatorcontrib><creatorcontrib>Jepsen, Ida E.</creatorcontrib><creatorcontrib>Sharif, Heidi</creatorcontrib><creatorcontrib>Zingenberg, Helle</creatorcontrib><creatorcontrib>Rosthøj, Susanne</creatorcontrib><creatorcontrib>Sørensen, Anne L.</creatorcontrib><creatorcontrib>Tolsgaard, Martin Grønnebæk</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Acta obstetricia et gynecologica Scandinavica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Andreasen, Lisbeth A.</au><au>Tabor, Ann</au><au>Nørgaard, Lone Nikoline</au><au>Taksøe‐Vester, Caroline A.</au><au>Krebs, Lone</au><au>Jørgensen, Finn S.</au><au>Jepsen, Ida E.</au><au>Sharif, Heidi</au><au>Zingenberg, Helle</au><au>Rosthøj, Susanne</au><au>Sørensen, Anne L.</au><au>Tolsgaard, Martin Grønnebæk</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Why we succeed and fail in detecting fetal growth restriction: A population‐based study</atitle><jtitle>Acta obstetricia et gynecologica Scandinavica</jtitle><addtitle>Acta Obstet Gynecol Scand</addtitle><date>2021-05</date><risdate>2021</risdate><volume>100</volume><issue>5</issue><spage>893</spage><epage>899</epage><pages>893-899</pages><issn>0001-6349</issn><eissn>1600-0412</eissn><abstract>Introduction
The objective of this study was to explore the association between detection of fetal growth restriction and maternal‐, healthcare provider‐ and organizational factors.
Material and methods
A historical, observational, multicentre study. All women who gave birth to a child with a birthweight <2.3rd centile from 1 September 2012 to 31 August 2015 in Zealand, Denmark, were included. The population was identified through the Danish Fetal Medicine Database. Medical charts were reviewed to obtain data regarding maternal characteristics and information on the healthcare professionals. Date of authorization for the midwives and obstetricians involved was extracted from the Danish Health Authorization Registry. Multivariable Cox regression models were used to identify predictors of antenatal detection of fetal growth restriction, and analyses were adjusted for hospital, body mass index, parity, the presence of at least one risk factor and experience of the first midwife, number of midwife visits, number of visits to a doctor, the experience of the consultant midwife or the educational level of the doctor, the number of scans and gaps in continuity of midwife‐care. Antenatal detection was defined as an ultrasound estimated fetal weight <2.3rd centile (corresponding to −2 standard deviations) prior to delivery.
Results
Among 78 544 pregnancies, 3069 (3.9%) had a fetal growth restriction. Detection occurred in 31% of fetal growth‐restricted pregnancies. Clinical experience (defined as years since graduation) of the first consultation midwife was positively associated with detection, with a hazard ratio [HR] of 1.15, 95% confidence interval [CI] 1.03‐1.28), for every 10 years of additional experience. The hazard of detection increased with the number of midwife consultations (HR 1.15, 95% CI 1.05‐1.26) and with multiparity (HR 1.28, 95% CI 1.03‐1.58). After adjusting for all covariates, an unexplained difference between hospitals (P = .01) remained.
Conclusions
The low‐risk nullipara may constitute an overlooked group of women at increased risk of antenatal non‐detection of fetal growth restriction. Being screened by experienced midwives during early pregnancy and having access to multiple midwife consultations may improve future diagnosis.</abstract><cop>United States</cop><pub>John Wiley & Sons, Inc</pub><pmid>33220065</pmid><doi>10.1111/aogs.14048</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-7831-2555</orcidid><orcidid>https://orcid.org/0000-0002-5634-2830</orcidid><oa>free_for_read</oa></addata></record> |
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| language | eng |
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| source | Wiley Online Library Journals Frontfile Complete |
| subjects | detection fetal growth restriction Fetuses Growth disorders Health risks Medical diagnosis Medical screening Midwifery Population-based studies Pregnancy Prenatal care Prenatal development small for gestation age |
| title | Why we succeed and fail in detecting fetal growth restriction: A population‐based study |
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