The stillbirth of a baby is devastating for the family involved and often also for the healthcare professionals present during the delivery of the child. Sixty-six per cent of all stillbirths have previously been classified as ‘unexplained’, adding to the distress of bereaved parents who are not provided with any answers as to why their child did not survive. Recent research, however, suggests that there is a significant link between stillbirth and those babies who are small for their gestational age or growth restricted.
Small for gestational age babies are those who fall below the tenth growth centile. This may be because they were meant to be small, or, alternatively, it may be indicative of a problem, such as chromosomal or metabolic issues with the baby, or problems with the placenta. In the latter situation, the baby is considered to have been growth restricted.
The association between fetal growth restriction and stillbirth, neonatal death and perinatal morbidity was recently given more consideration by Professor Gardosi, of the Perinatal Institute. He identified that most ‘unexplained’ stillbirths were growth restricted (pregnancies with fetal growth restriction have a seven fold higher risk of stillbirth) and, significantly, most stillbirths due to growth restriction were avoidable. He further, and, unsurprisingly, identified that antenatal identification of growth restriction improved the outcome and reduced the incidence of stillbirth.
It is therefore important to differentiate between those babies who should be small and those who are small because they are struggling, so that these babies may be managed effectively.
Professor Gardosi spoke at the recent AvMA conference about the Growth Assessment Protocol (GAP) Programme, which provides a comprehensive tool for the assessment of fetal growth and birth weight by defining each pregnancy’s growth potential through the Gestational Related Optimal Weight (GROW) software. This software is currently in use at 104 out of 164 healthcare trusts throughout England, Wales, Scotland and Northern Ireland.
One of the main features of GROW is the use of a customised growth chart which is individually adjusted and optimised, taking into account the mother’s weight, height and the birthweight of any previous children, thereby offering more of an opportunity for those babies whose limited growth is indicative of difficulties to be identified and appropriately managed. This management may involve delivery at 37 weeks if growth has become static and, in more serious cases, delivery at 32 weeks if investigations show that the baby’s blood flow from the placenta is compromised.
Helen Hammond, associate in the clinical negligence team, who has a special interest in obstetric care, comments: “I have represented too many families who have suffered the complete devastation of an avoidable stillbirth. I therefore strongly support any steps taken to limit the number of stillbirths and hope to see a complete uptake of GROW nationally as soon as possible.”
If you have experienced the stillbirth of a child and have questions about whether this could have been avoided, please contact Helen Hammond in our Basingstoke office on 01256 407150.