Antenatal Detection Rate of Foetal Growth Restriction in Primary Healthcare Centres: A Service Evaluation From Dammam, Saudi Arabia

Introduction We aimed to evaluate the antenatal detection of foetal growth restriction (FGR) in pregnant women receiving care at primary healthcare centres (PHCCs) in Dammam, Saudi Arabia. Methods This prospective cohort study was conducted as a service evaluation of routine antenatal care pathways in PHCCs in Dammam, Saudi Arabia. Pregnant women who underwent dating scans between January and May 2024 were enrolled and followed up until December 2024 to identify and detect FGR using standardised ultrasonography based on the Delphi consensus criteria. Results Among 210 pregnancies with complete birth outcomes, 19 neonates (9.0%; 95% confidence interval (CI): 5.9%-13.7%) were identified as having FGR. Of these, 12 (63.2%; 95% CI: 41.0%-80.9%) were detected antenatally at PHCCs using the Delphi consensus criteria, and seven (36.8%) were identified postnatally, corresponding to women who missed the scheduled third-trimester ultrasonography examination (growth scan) at 32-36 weeks. Most participants completed the follow-up (90.5%; 210/232; 95% CI: 86.1%-93.7%). Conclusion FGR was identified in 9% of pregnancies within the PHCCs. However, a considerable proportion of FGR cases remain undiagnosed antenatally, largely because of missed third-trimester growth scans, which underlie these undetected cases and underscore the need for improved adherence to scheduled ultrasonography. PHCCs can be the first line of surveillance for FGR when supported by structured systems and trained staff.