121: Evaluation of a surveillance protocol for the management of fetal growth restriction

A standardized surveillance protocol to minimize variation in the management of fetal growth restriction (FGR; estimated fetal weight < 10% for gestational age [GA]) was developed and instituted. The objective of this pre- and post-intervention study was to evaluate the impact of our protocol on maternal and neonatal outcomes. We performed an IRB approved retrospective analysis of all singleton, non-anomalous pregnancies with FGR at our institution from January 2008 to July 2012. After March 2010, a protocol consisting of standardized fetal surveillance and delivery indications was initiated for the management all suspected FGR (Figure 1). We hypothesized that the GA at delivery would increase with a corresponding decrease in neonatal ICU admissions after protocol initiation. We estimated 194 patients in each group would detect a mean difference in GA of 4 days (SD = 2 weeks) between pre- and post-intervention groups. 230 pre- and 306 post- intervention pregnancies met inclusion criteria. Maternal characteristics including age, GA at diagnosis, BMI, nulliparity, and maternal co-morbidities were similar between groups. There was a significant increase in mean GA at delivery (p=.003), and total number of Doppler ultrasounds (p=.01) in the post-intervention cohort. There were no differences in induction rates, mode of delivery, or composite neonatal morbidity with a significant decrease in delivery <37 weeks (p=0.002) and a non-statistically significant trend in number of NICU admissions (p=0.06). A protocol for surveillance of FGR prolonged the GA at delivery and decreased preterm births with no change in composite neonatal morbidity.