PA.44 How will the updated March 2013 RCOG Green-top Guideline 'The Investigation and Management of the Small-for-Gestational-Age Fetus' impact our antenatal maternity services? Will there be a service provision gap impacting our ability to adhere to the recommended guidance?

INTRODUCTION: Small for gestational age (SGA) fetuses are at increased risk of perinatal morbidity and mortality. The new RCOG SGA Guideline recommends screening for minor and major risk factors at booking to identify those pregnancies at risk of SGA in order to implement an increased fetal growth surveillance schedule using ultrasound.

AIM: To establish the feasibility of adhering to the new guideline and its potential impact on antenatal maternity services.

METHOD: A retrospective review of 58 case notes of women who delivered at Nottingham City Hospital between July and August 2013 was undertaken; this represents approximately 1% of the unit's annual delivery rate. Data was collected from the hospital notes based on the women's risk factors for SGA at booking.

RESULTS: Based on current unit practice, 8 of the 58 women were planned for serial fetal growth ultrasounds. 7 women had at least one additional ultrasound organised that was not initially planned.16 third trimester ultrasounds were performed on women who developed risk factors for SGA during the pregnancy. Using the new RCOG screening tool, 22 of the 58 women reviewed would require additional ultrasounds. We estimated a minimum of two additional ultrasounds would be required for each of these 22 women.

CONCLUSIONS: In our sample, 42 third trimester ultrasounds were performed. The estimated minimum number of ultrasounds using the RCOG guideline is 60; an increase of 42.8%. If extrapolated to the unit population, there will be an impact on the capacity of our sonographer service and antenatal clinics.