OP05.08: The introduction of a fetal growth decision‐tool to improve consistency in management of ultrasound findings in late pregnancy

Aim: To introduce an algorithm to increase consistency of decisions made following growth scans. A retrospective cohort in a UK tertiary unit (2018-2019) to compare pre (n = 53) and postadherence (n = 60) to the ‘small for gestational age’ (SGA) guideline. Inclusion criteria: singleton pregnancies, morphologically normal, >34 weeks. The output from the tool uses biometry and the ratio of Middle Cerebral Artery (MCA) Pulsatility Index to Umbilical Artery (UA)-PI to calculate the Cerebral Placental Ration (CPR) multiples of the median (MoM). CPR MoM < 5th centile (0.67) is used as a threshold. Prior to tool introduction, clinicians interpreted a written guideline describing growth parameters and Doppler readings and acted upon these. After introduction, an algorithm output was used (see figure 1). Prior to introduction of the tool, there was a scan rate of 0.53 (5483 births, 2896 growth scans) which increased in 2019 to 0.57 per birth (5351 births, 3048 growth scans). Scan outcomes were equivalent (normal growth/Doppler 81 (80%) vs 45 (76%), biometry >95thcentile (6 (6%) vs 8 (14%), growth tailing 6 (6%) vs 3 (5%), polyhydramnios 4 (4%) vs 1 (2%), inconclusive 2 (2%) vs 1 (2%). There was an increase in the adherence to the guideline from 94% to 98%. The decision aid improves adherence to guidelines and making consistent decisions. There was no reduction in the number of repeat growth scans. However, there was pressure from other indications leading to a rise in indications for and number of scans requested. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.