Table 4.
Management in obstetrician-led care in case of suspected IUGR 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 (%) | |||
| 3.1. If additional tests (Doppler, amniotic fluid volume, FAS and on indication: invasive prenatal testing and assessment of infections) show no anomalies, in which level of care should the pregnancy with EFW (and/or AC) P2.3 - P5 be continued? | Continue in midwife-led care | 0 | 0 | Consensus: Continue in obstetrician-led care |
| Continue in midwife-led care and offer serial ultrasound biometry | 6 (26%) | 3 (12%) | ||
| Continue in obstetrician-led care | 17 (74%) | 23 (88%) | ||
| N | 0 | 0 | ||
| M | 4 | 3 | ||
| 3.2. If the EFW on the CGC is P5-P10, the pregnancy should be continued: | In midwife-led care with serial ultrasound biometry | 18 (78%) | 12 (44%) | No consensus |
| In obstetrician-led care | 5 (22%) | 15 (56%) | ||
| N | 0 | 0 | ||
| M | 4 | 2 | ||
| 3.3. If a pregnancy needs to be monitored in obstetrician-led care because of suspicion of IUGR, ultrasound biometry should be repeated: | Every day | 0 | 0 | Consensus: Every 2 weeks |
| Every other day | 0 | 0 | ||
| Twice a week | 0 | 2 (8%) | ||
| Once a week | 3 (16%) | 2 (8%) | ||
| Every 10 days | 1 (5%) | 2 (8%) | ||
| Every 2 weeks | 14 (74%) | 18 (72%) | ||
| With another frequency | 1 (5%) | 1 (4%) | ||
| Ultrasound biometry should not be part of the routine monitoring | 0 | 0 | ||
| N | 4 | 1 | ||
| M | 4 | 3 | ||
| 3.4. If a pregnancy needs to be monitored in obstetrician-led care because of suspicion of IUGR, assessment of the amniotic fluid volume should be repeated: | Every day | 0 | 0 | No consensus |
| Every other day | 0 | 0 | ||
| Twice a week | 1 (5%) | 1 (4%) | ||
| Once a week | 4 (21%) | 18 (72%) | ||
| Every 10 days | 1 (5%) | 1 (4%) | ||
| Every 2 weeks | 9 (48%) | 2 (8%) | ||
| With another frequency | 3 (16%) | 3 (12%) | ||
| Amniotic fluid volume should not be routinely monitored | 1 (5%) | 0 | ||
| N | 4 | 1 | ||
| M | 4 | 3 | ||
| 3.5. If a pregnancy needs to be monitored in obstetrician-led care because of suspicion of IUGR, assessment of the umbilical artery Doppler should be repeated: | Every day | 0 | 0 | No consensus |
| Every other day | 0 | 0 | ||
| Twice a week | 2 (11%) | 2 (8%) | ||
| Once a week | 7 (39%) | 15 (60%) | ||
| Every 10 days | 1 (5%) | 1 (4%) | ||
| Every 2 weeks | 2 (11%) | 0 | ||
| With another frequency | 5 (28%) | 7 (28%) | ||
| Umbilical artery Doppler should not be routinely monitored | 1 (5%) | 0 | ||
| N | 5 | 1 | ||
| M | 4 | 3 | ||
| 3.6. In the IRIS study a tertiary care centre should be consulted about the administration of MgSO4 for fetal neuroprotection if there is suspicion of severe IUGR at a gestational age < 32 weeks 0 days. | A | 6 (100%) | 20 (87%) | Consensus: agree |
| D | 0 | 3 (13%) | ||
| N | 17 | 4 | ||
| M | 4 | 2 |
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, FAS fetal anomaly scan, EFW estimated fetal weight, AC abdominal circumference, CGC customised growth chart, IRIS IUGR risk selection, MgSO4 magnesium sulphate