Accuracy of clinical suspicion of growth restriction at term despite a normal growth ultrasound: A retrospective cohort study

BACKGROUND: Small for gestational age (SGA) is a major determinant of poor perinatal outcome. Detecting SGA at term using ultrasound is challenging and we often plan birth based on clinical assessment. AIMS: To determine the incidence of SGA infants with birthweight /=35 weeks reporting an EFW >/= 10th centile (appropriate for gestational age, AGA) who subsequently had an induction of labour or caesarean birth at >/=37 weeks due to ongoing clinical suspicion of SGA between 2012-2014. The primary outcome was the incidence of SGA newborns using customised centiles. RESULTS: There were 532 women who had a planned birth for clinical suspicion of SGA during the study period. Of these, 205 (38.5%) had an AGA fetus on ultrasound >/=35 weeks but were subsequently delivered because of a persisting clinical suspicion of SGA on abdominal assessment. Sixty-eight percent (n = 139/205) delivered an SGA infant. Furthermore, almost half of these SGA infants (47.5%) had a birthweight /=10th centile in the late third trimester should not override clinical concerns of impaired fetal growth at term.