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Fall in stillbirths in UK not due to new protocol?

A new study suggests that the dramatic fall in stillbirths is not due to the adoption of new growth assessement protocols in pregnancy.

In 2015, the Secretary of State for Health in the UK announced a national ambition to halve the rates of stillbirths, neonatal and maternal deaths and brain injuries at birth by 2030, with a 20% reduction by 2020.

The target is well on track to be met.  But what lies behind its success.  It was thought that it was the result of new protocols for assessing the growth of the baby in the womb.

By comparing the growth of the fetus with expected growth for gestational age can indicate if something is going wrong.  For this vital assessment, growth charts are used.  The problem with the older growth charts was that they took no account of heterogeneity in the population.  More accurate growth assessment could save the lives of babies if problems could be detected sufficiently early in pregnancy.

One approach in recent years has been the adoption of a Growth Assessment Protocol.  

The customised growth chart concept was developed initially in Nottingham in the early 1990s. While recognising the importance of growth for fetal well being, it had become increasingly clear that existing growth charts were not useful for clinical assessment in a heterogeneous maternity population.



Since the adoption of the Growth Assessment Protocol, stillbirths have been falling, but to what extent is this due to the new protocol? 

The adoption of the protocol was adopted later in Scotland than in England and Wales, and this has provided a unique opportunity to compare outcomes of the old versus the new protocol. 

In the UK, the promotion of customized centiles has been through a package of care known as the Growth Assessment Protocol (GAP) which trains midwives and healthcare professionals in fetal growth assessment and the use of customized centiles (those that take account of the mix in the population).

Now, a study published in Ultrasound in Obstetrics & Gynecology brings into question claims that the fall in stillbirths is due to the new protocol.

By studying more than 11 million singleton pregnancies in UK regions with similar healthcare systems, the study’s investigators demonstrated that the stillbirth rate in Scotland declined faster than in England and Wales between 2010 and 2015, despite a significantly lower uptake of the GAP program in Scotland.

The findings suggest that the reduction in stillbirth rate in England and Wales cannot be attributed solely to the implementation of the GAP program.

The greater decline in the stillbirth rate in Scotland, despite the low uptake of the programme, suggests that other beneficial public health measures common to both systems are responsible. 

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