A. Jahn et al., ROUTINE SCREENING FOR INTRAUTERINE GROWTH-RETARDATION IN GERMANY - LOW-SENSITIVITY AND QUESTIONABLE BENEFIT FOR DIAGNOSED CASES, Acta obstetricia et gynecologica Scandinavica, 77(6), 1998, pp. 643-648
Background. Antenatal screening for fetal growth retardation has prove
n effective in detecting at-risk pregnancies under study conditions. I
t is also widely believed to improve pregnancy outcomes. We assessed s
ensitivity of antenatal screening routines for intrauterine growth ret
ardation under routine service conditions in Germany. We then compared
pregnancy management and outcome in small for gestational age neonate
s with antenatally diagnosed growth retardation to neonates whose grow
th retardation had remained undetected. Methods. Historical prospectiv
e study covering all 2378 singleton pregnancies with antenatal records
delivered within a one-year period at a tertiary level maternity hosp
ital in Germany. Antenatal records were linked with pregnancy outcome
data. Results. The sensitivity of screening routines based on ultrasou
nd and non-systematic followup investigations was 32% as compared to 8
0-90% reported for ultrasound screening under study conditions. An ant
enatal diagnosis of intrauterine growth retardation was associated wit
h a 5 times higher rate of preterm delivery (p<0.001), mainly as a con
sequence of medical interventions to avoid fetal compromise, when comp
ared to new-horns with growth retardation not detected before delivery
; admission rates to neonatal care unit were 3 times higher (p<0.001).
The proportion of low Apgar scores and low cord pH, indicating fetal d
istress, was not significantly different in detected and undetected ca
ses. Conclusion. Screening routines for intrauterine growth retardatio
n currently used in Germany miss the majority of cases and do not cont
ribute towards improved pregnancy outcome in detected cases. A benefit
of elective preterm delivery in the management of suspected intrauter
ine growth retardation was not evident.