Routine clinical policy and application of Doppler measurements in suspected intrauterine growth retardation in university hospitals in The Netherlands

Suspected intrauterine growth retardation is a clinical problem with financial consequences, as it can lead to costly, in-hospital fetal monitoring. At present, no prospective ‘gold standard’ for growth retardation exists. Hence, a proportion of the fetuses suspected are likely to be genetically small, in which case hospitalisation is superfluous. Doppler ultrasound measurements might be applied to differentiate between growth retardation and genetically based smallness. Before the diagnostic effectiveness of Doppler ultrasound can be evaluated, however, the magnitude of the problem of suspected intrauterine growth retardation, or what it is experienced to be, must be known. The occurrence of suspected intrauterine growth retardation, routine clinical policy, and use of Doppler ultrasound techniques were assessed by a questionnaire among obstetricians in the university hospitals in The Netherlands. Of the obstetricians approached, 81% responded ( 59 73 ). Intrauterine growth retardation was defined mainly by a lag in fundal height of at least 3 weeks. It is suspected in about 11% of singleton pregnancies. An estimated 70% of those suspected of growth retardation are hospitalised. Fewer than half of the respondents thought Doppler ultrasound measurements an asset to antenatal diagnosis. Five of the eight university hospital clinics used Doppler measurements in clinical decision making. Sixty percent of responding obstetricians were of the opinion that there was a ‘routine clinical policy’ in suspected intrauterine growth retardation.