PFM.17 Audit of the management of the small for gestation age (SGA) fetus against RCOG (2002) and regional guidelines: Case recognition and implications for the next regional guideline.

AIM: To evaluate the management of the SGA fetus against the current Greater Glasgow and Clyde guideline, based upon the 2002 RCOG guidance.

METHOD: The audit was carried out over a 3 month period during 2011. All cases presenting to ultrasound assessment with structurally normal singleton fetus with either an AC <10th centile (H1 and H3,) or an EFW <10th centile (H2) were included.

RESULTS: 133 cases of SGA were identified in the current audit: H1-16/1500 deliveries, H2-93/700 deliveries, H3-24/1500 deliveries. Non-customised centile charts are in use in hospitals 1 and 3. Hospital 2 utilises customised centile charts. Umbilical artery Doppler was performed in 98% of cases at identification. 120 cases demonstrated normal liquor volume and positive UA EDFV. If these cases remained undelivered repeat ultrasound assessments were performed at weekly (24 cases) or fortnightly intervals (67 cases). 118 women delivered at ≥37 week gestation. The birth weight of 57% of babies was >10th centile.

CONCLUSIONS: Current regional guidelines allow the use of customised or non-customised fetal growth charts on the basis of historical resource allocation. Customised charts appear to overestimate and non-customised charts underestimate the identification of the SGA fetus in our population. Update of regional guidance to reflect recent RCOG recommendations (2013) will almost certainly improve case recognition of the SGA fetus. To effect this, and potentially benefit the outcome of these fetuses, we face challenges as a consequence of a net estimated increased demand on our already stretched ultrasound resource.