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Routine ultrasound examination at 41 weeks of gestation and risk of post‐term severe adverse fetal outcome: a retrospective evaluation of two units, within the same hospital, with different guidelines
Author(s) -
Lindqvist PG,
Pettersson K,
Morén A,
Kublickas M,
Nordström L
Publication year - 2014
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.12654
Subject(s) - medicine , retrospective cohort study , gestation , adverse effect , gestational age , confidence interval , obstetrics , asphyxia , confounding , population , logistic regression , pregnancy , pediatrics , surgery , genetics , environmental health , biology
Objective To study whether a routine with a routine ultrasound examination (routine scan) at 41 gestational weeks as compared with ultrasound on clinical indication (indicated scan), lowered the risk of severe adverse fetal outcome in post‐term period. Design A retrospective cohort study. Setting K arolinska U niversity H ospital, S tockholm, S weden. Population Eight years of deliveries, 2002–2009. Method One of the two delivery units at K arolinska U niversity H ospital used a routine scan at 41 week of gestation and the other unit used an indicated scan. Severe adverse fetal outcome were defined: severe asphyxia, death or cerebral damage. The study was analysed using logistic regression with adjustment for potential confounders. Main outcome measures Differences in post‐term severe adverse fetal outcome. Results No increased risk of post‐term severe adverse fetal outcome was seen at the unit using a routine scan; conversely, a 48% significantly increased risk was seen at the unit using an indicated scan ( OR 0.89, 95% confidence interval, CI , 0.5–1.5 and OR 1.48, 95% CI 1.06–2.1, respectively). Comparing post‐term periods, there was no significantly increased risk at the unit using indicated scans ( OR 1.6, 95% CI 0.9–3.0). There was a 60% increased prevalence of small‐for‐gestational age ( SGA ) newborns in the post‐term period at the unit using indicated scans ( OR 1.6, 95% CI 1.1–2.4), but no differences in operative delivery. Conclusion A policy to use routine scans at 41 weeks of gestation seems to normalise an increased post‐term risk of severe adverse fetal outcome, possible due to increased awareness of SGA and/or oligohydramniosis.