ROUTINE SCREENING FOR INTRAUTERINE GROWTH-RETARDATION IN GERMANY - LOW-SENSITIVITY AND QUESTIONABLE BENEFIT FOR DIAGNOSED CASES

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.