England has one of the highest rates of stillbirth in Europe. Babies that are small for their gestational age (SGA) are at a significantly raised risk of stillbirth when compared to normally grown babies, particularly when problems with their growth have not been identified. Only around 30-40% of these babies are identified during pregnancy.
The Oxford AHSN Maternity Clinical Network conducted an audit, looking at the identification of small for gestational age across the Oxford AHSN region. It found that overall, 36.7% of SGA babies (range in different units: 26.7% – 44.4%) were identified antenatally.
In May 2016, the Network launched an ambitious and innovative pilot project designed to increase the detection of babies who are at risk of stillbirth. All women using Oxford University Hospitals NHS Foundation Trust maternity services are now offered an extra ultrasound scan at 36 weeks focusing on the growth and wellbeing of their baby. In addition, simple risk stratification and an additional non-invasive test (uterine artery doppler) at the 20-week anomaly scan should make it easier to identify and arrange appropriate treatment for sick and small babies. This should also reduce the risk of birthing complications which can have a lifelong impact.
As women are offered these additional tests and scans, there should be fewer unnecessary routine and ad hoc scans. Monitoring of the baby’s wellbeing becomes more structured, planned and clinically effective in an environment where resources are limited. Ultimately, it should bring about a reduction in the total number of extra scans needed.
Subject to a review of the outcomes of the project over the next 18 months, it is planned to offer the new ultrasound pathway to other hospitals in the Oxford AHSN region where a total of 30,000 women give birth every year.