Multidisciplinary consensus on screening for, diagnosis and management of fetal growth restriction in the Netherlands
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Publication date
2017-10-16
Authors
Verfaille, Viki
de Jonge, Ank
Mokkink, Lidwine
Westerneng, Myrte
van der Horst, Henriëtte
Jellema, Petra
Franx, Arie
Bais, Joke M J
Bonsel, G. J.
Bosmans, Judith E
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Article
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Abstract
Background: Screening for, diagnosis and management of intrauterine growth restriction (IUGR) is often performed in multidisciplinary collaboration. However, variation in screening methods, diagnosis and management of IUGR may lead to confusion. In the Netherlands two monodisciplinary guidelines on IUGR do not fully align. To facilitate effective collaboration between different professionals in perinatal care, we undertook a Delphi study with uniform recommendations as our primary result, focusing on issues that are not aligned or for which specifications are lacking in the current guidelines. Methods: We conducted a Delphi study in three rounds. A purposively sampled selection of 56 panellists participated: 27 representing midwife-led care and 29 obstetrician-led care. Consensus was defined as agreement between the professional groups on the same answer and among at least 70% of the panellists within groups. Results: Per round 51 or 52 (91% - 93%) panellists responded. This has led to consensus on 27 issues, leading to four consensus based recommendations on screening for IUGR in midwife-led care and eight consensus based recommendations on diagnosis and eight on management in obstetrician-led care. The multidisciplinary project group decided on four additional recommendations as no consensus was reached by the panel. No recommendations could be made about induction of labour versus expectant monitoring, nor about the choice for a primary caesarean section. Conclusions: We reached consensus on recommendations for care for IUGR within a multidisciplinary panel. These will be implemented in a study on the effectiveness and cost-effectiveness of routine third trimester ultrasound for monitoring fetal growth. Research is needed to evaluate the effects of implementation of these recommendations on perinatal outcomes. Trial registration:NTR4367.
Keywords
Collaboration, Delphi technique, Fetal growth restriction, Intrauterine growth restriction, Practice guideline, Prenatal ultrasonography, Uniform approach, Humans, Intersectoral Collaboration, Pregnancy Trimester, Third, Consensus, Pregnancy, Interdisciplinary Communication, Netherlands, Delphi Technique, Fetal Growth Retardation/diagnosis, Female, Practice Guidelines as Topic/standards, Prenatal Care/methods, Ultrasonography, Prenatal/methods, fetal growth restriction, Obstetrics and Gynaecology, Journal Article
Citation
Verfaille, V, de Jonge, A, Mokkink, L, Westerneng, M, van der Horst, H, Jellema, P, Franx, A, Bais, J M J, Bonsel, G J, Bosmans, J E, van Dillen, J, van Duijnhoven, N T L, Grobman, W A, Groen, H, Hukkelhoven, C W P M, Klomp, T, Kok, M, de Kroon, M L, Kruijt, M, Kwee, A, Ledda, S, Lafeber, H N, van Lith, J M, Mol, B W, Molewijk, B, Nieuwenhuijze, M, Oei, G, Oudejans, C, Paarlberg, K M, Pajkrt, E, Papageorghiou, A T, Reddy, U M, de Reu, P A O M, Rijnders, M E B, de Roon-Immerzeel, A, Scheele, C, Scherjon, S A, Snijders, R, Teunissen, P W, Torij, H W, Twisk, J W, Zeeman, K C, Zhang, J & IRIS study group 2017, 'Multidisciplinary consensus on screening for, diagnosis and management of fetal growth restriction in the Netherlands', BMC Pregnancy and Childbirth [E], vol. 17, no. 1, pp. 353-369. https://doi.org/10.1186/s12884-017-1513-3