Table 2.
Screening for IUGR in midwife-led care at a gestational age ≥ 26 weeks 0 days: opinion per level of care
| Statement | Answer | Midwife-led Care | Obstetrician-led Care | Consensus total group |
|---|---|---|---|---|
| n (%) | n (%) | |||
| 1.1. Slow growth should be defined as a decrease of a specified number of centiles of SFH measurements on the CGC. Eye-balling is of secondary importance. | A | 20 (87%) | 26 (93%) | Consensus: agree |
| D | 3 (13%) | 2 (7%) | ||
| N | 0 | 0 | ||
| M | 4 | 1 | ||
| 1.2. Slow growth is a decrease of at least 20 centiles (e.g. from P70 to P50, with a minimum interval of 2 weeks) of SFH measurements on the CGC. This is an indication for an ultrasound biometry. | A | 20 (91%) | 20 (91%) | Consensus: agree |
| D | 2 (9%) | 2 (9%) | ||
| N | 3 | 4 | ||
| M | 2 | 3 | ||
| 1.3. With ultrasound biometry, slow growth should be stated as a decrease of a specified number of centiles of EFW on the CGC. Eye-balling is of secondary importance in this evaluation. | A | 22 (96%) | 25 (89%) | Consensus: agree |
| D | 1 (4%) | 3 (11%) | ||
| N | 0 | 0 | ||
| M | 4 | 1 | ||
| 1.4. With ultrasound biometry, slow growth is a decrease of at least 20 centiles (e.g. from P70 to P50, with a minimum interval of 2 weeks) of EFW on the CGC. This is an indication for referral to obstetrician-led care. | A | 20 (91%) | 20 (83%) | Consensus: agree |
| D | 2 (9%) | 4 (17%) | ||
| N | 2 | 2 | ||
| M | 3 | 3 | ||
| 1.5. In the IRIS study it will be advised, not obligatory, that two consecutive biometry ultrasounds are performed by the same sonographer | A | 22 (96%) | 20 (71%) | Consensus: agree |
| D | 1 (4%) | 8 (29%) | ||
| N | 0 | 0 | ||
| M | 4 | 1 | ||
| 1.6. To guarantee quality in the IRIS study, sonographers who are trained for the 18–23 weeks FAS are preferable, however other sonographers are acceptable if at least trained in biometry until 3rd trimester. | A | 18 (82%) | 23 (82%) | Consensus: agree |
| D | 4 (18%) | 5 (18%) | ||
| N | 1 | 0 | ||
| M | 4 | 1 | ||
| 1.7. To guarantee quality, sonographers should obtain a minimum number of credits from their professional organization, by following a training once a year. | A | 20 (83%) | 17 (71%) | Consensus: agree |
| D | 4 (17%) | 7 (29%) | ||
| N | 0 | 2 | ||
| M | 3 | 3 | ||
| 1.8. To guarantee quality, sonographers should perform at least 100 biometry ultrasounds a year | A | 18 (90%) | 22 (96%) | Consensus: agree |
| D | 2 (10%) | 1 (4%) | ||
| N | 4 | 3 | ||
| M | 3 | 3 | ||
| 1.9. Ultrasound quality should be checked yearly, evaluation of a log should be an essential part of this | A | 20 (87%) | 19 (86%) | Consensus: agree |
| D | 3 (13%) | 3 (14%) | ||
| N | 1 | 4 | ||
| M | 3 | 3 | ||
| 1.10. The ultrasound machine should meet the requirements for 18–23 weeks FAS as stated by the NVOG quality norm ‘Fetal ultrasound’16 | A | 12 (80%) | 15 (79%) | Consensus: agree |
| D | 3 (20%) | 4 (21%) | ||
| N | 9 | 7 | ||
| M | 3 | 3 | ||
| 1.11. Which cut-off value for the single deepest vertical pocket measurement for assessing amniotic fluid volume is an indication for referral to obstetrician-led care? | < P 2.3 | 0 | 2 (7%) | No consensus |
| < P5 | 6 (40%) | 11 (39%) | ||
| <2 cm (regardless of gestational age) | 9 (60%) | 15 (54%) | ||
| N | 8 | 0 | ||
| M | 4 | 1 |
A agree, D disagree, N no opinion/expertise, M missing: panellist has not participated in this round or has not answered this question, Consensus = ≥70% of panellists per level of care agree and both groups agree upon the same. Percentages do not always add up to 100% due to rounding error
IUGR intrauterine growth restriction, SFH serial fundal height, CGC customised growth chart, EFW estimated fetal weight, IRIS IUGR risk selection, FAS fetal anomaly scan, NVOG Dutch Society of Obstetrics and Gynaecology