The Utility of Customised Growth Charts for Identifying Macrosomia and the Effect of Intervention

Newcastle University

Status: Completed

Conditions: Induction of Labor Affected Fetus / Newborn; Fetal Growth Complications; Obstetric Complication; Ultrasound

Treatments: Procedure: Induction of labour

Study type: Observational

Funder types: Other

Identifiers

NCT04536753

SIMPS01

Details and patient eligibility

About

Best management of suspected large for gestational age (LGA) fetuses is unclear. In some hospitals women with an LGA fetus by customised growth charts are are offered earlier induction. This study aimed to examine scan accuracy for this group and the outcome with intervention.

Full description

This is a retrospective cohort study of pregnant women taken from 3 groups; women with a suspected LGA fetus (LGA), women with diabetes (DM) and a control group of women that underwent induction of labour at or after 40 weeks. Scan accuracy using GROW and WHO charts in the LGA and DM cohorts was assessed using ROC curves and outcomes between the cohorts was compared.

Enrollment: 845 patients

Sex: Female

Volunteers: No Healthy Volunteers

Inclusion criteria

• Induced labour of a singleton pregnancy at Northumbria Healthcare Foundation trust resulting in a delivery between 01/01/2018 and 31/12/2018.

Inclusion in the LGA group means that the main indication for induction is recorded as suspected macrosomia.

Inclusion in the Diabetic group means diabetes was pre-existing or arose in pregnancy, diagnosed by oral glucose tolerance testing from 24-30 weeks or by home blood glucose monitoring with standard thresholds as per NICE ng3. Induction had to be undertaken with diabetes as the (co)indication.

Inclusion criteria for the control group was induction of labour at or after 280 days gestation

Exclusion criteria

Previous caesarean section Multiple pregnancy Fetal concerns pre-induction: abnormal antenatal trace or abnormal doppler flow studies on antenatal ultrasound

• Cases of induction for suspected LGA are to be excluded if there is a co-indication of obstetric cholestasis, hypertensive disorder or diabetes.

Trial design

845 participants in 3 patient groups

Suspected large for gestational age (LGA)

Description:

Women with pregnancies suspected to be complicated by fetuses weighing more than the 90th centile on customised growth chart and induced for this reason prior to 287 days as the main indication without diabetes.

Treatment:

Procedure: Induction of labour

Women with diabetes (DM)

Description:

Women with diabetes in pregnancy induced at between 259 and 266 days if on treatment and 273 days if gestational diabetes managed with diet alone.

Treatment:

Procedure: Induction of labour

Control

Description:

All other women induced at or after 280 days of gestation

Treatment:

Procedure: Induction of labour