PDF herunterladen
Am J Perinatol 2022; 39(15): 1605-1613
DOI: 10.1055/a-1877-8478
SMFM Fellowship Series Article

Impact of a Hybrid Model of Prenatal Care on the Diagnosis of Fetal Growth Restriction

Marti D. Soffer 
1   Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts
,
Colleen Sinnott
2   Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
,
Mark A. Clapp 
1   Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts
,
Sarah N. Bernstein
1   Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts
› Institutsangaben
› Weitere Informationen
    Lizenzen und Reprints

Abstract

Objective Fetal growth restriction (FGR) is associated with poor neonatal outcomes and stillbirth, and screening via fundal height or ultrasound is routinely performed. During the novel coronavirus disease 2019 (COVID-19) pandemic, we developed a hybrid model of prenatal care which decreased the frequency of in-person visits and incorporated telemedicine visits. We sought to determine if prenatal FGR diagnoses decreased with this hybrid model compared with routine prenatal care.

Study Design This was a retrospective cohort study of singleton nonanomalous neonates with birth weights <10th percentile at term. The “routine care” group was consisted of those who born between April and July 2019 with in-person prenatal care, and the “hybrid care” group was consisted of those who born between April and July 2020 with both in-person and telemedicine prenatal cares at a collaborative academic practice. The primary outcome was the rate of diagnosis of small for gestational age (SGA) as defined as infant birth weight <10th percentile without a prenatal diagnosis of FGR. The secondary outcome was timing of diagnosis of FGR.

Results Overall, 1,345 and 1,296 women gave birth in the routine and hybrid groups, respectively. The number of in-person prenatal care visits decreased from 15,024 in the routine period to 7,727 in the hybrid period; 3,265 telemedicine visits occurred during the hybrid period. The total number of prenatal patients remained relatively stable at 3,993 and 3,753 between periods. Third trimester ultrasounds decreased from 2,929 to 2,014 between periods. Birth weights <10 percentile occurred in 115 (8.6%) births during the routine period and 79 (6.1%) births during the hybrid period. Of 115, 44 (38.3%) cases were prenatally diagnosed with FGR in the routine versus 28 of 79 (35.4%) in the hybrid group (p = 0.76). Median gestational age at diagnosis did not vary between groups (36 vs. 37 weeks, p = 0.44).

Conclusion A hybrid prenatal care model did not alter the detection of FGR. Future efforts should further explore the benefits of incorporating telemedicine into prenatal care.

Key Points

  • Telemedicine visits can provide comprehensive prenatal care.

  • FGR was diagnosed equally with hybrid versus routine prenatal care.

  • FGR diagnosis was not delayed with hybrid care.

Keywords

fetal growth restriction - telemedicine - prenatal care - prenatal diagnosis

Note

The findings of this paper was presented at the 41st Annual Society for Maternal-Fetal Medicine Virtual Meeting, January 25–30, 2021.


Supplementary Material



Publikationsverlauf

Eingereicht: 22. April 2021

Angenommen: 03. Juni 2022

Accepted Manuscript online:
16. Juni 2022

Artikel online veröffentlicht:
23. August 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Martins JG, Biggio JR, Abuhamad A. Society for Maternal-Fetal Medicine (SMFM). Electronic address: pubs@smfm.org. Society for Maternal-Fetal Medicine Consult Series #52: diagnosis and management of fetal growth restriction: (replaces Clinical Guideline Number 3, April 2012). Am J Obstet Gynecol 2020; 223 (04) B2-B17
    Google Scholar
  • 2 Getahun D, Ananth CV, Kinzler WL. Risk factors for antepartum and intrapartum stillbirth: a population-based study. Am J Obstet Gynecol 2007; 196 (06) 499-507
    CrossrefPubMedGoogle Scholar
  • 3 Belizán JM, Villar J, Nardin JC, Malamud J, De Vicurna LS. Diagnosis of intrauterine growth retardation by a simple clinical method: measurement of uterine height. Am J Obstet Gynecol 1978; 131 (06) 643-646
    CrossrefPubMedGoogle Scholar
  • 4 Sovio U, White IR, Dacey A, Pasupathy D, Smith GCS. Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study. Lancet 2015; 386 (10008): 2089-2097
    CrossrefPubMedGoogle Scholar
  • 5 Ashimi Balogun O, Sibai BM, Pedroza C, Blackwell SC, Barrett TL, Chauhan SP. Serial third-trimester ultrasonography compared with routine care in uncomplicated pregnancies: a randomized controlled trial. Obstet Gynecol 2018; 132 (06) 1358-1367
    CrossrefPubMedGoogle Scholar
  • 6 Bricker L, Medley N, Pratt JJ. Routine ultrasound in late pregnancy (after 24 weeks' gestation). Cochrane Database Syst Rev 2015; (06) CD001451
    PubMedGoogle Scholar
  • 7 Figueras F, Caradeux J, Crispi F, Eixarch E, Peguero A, Gratacos E. Diagnosis and surveillance of late-onset fetal growth restriction. Am J Obstet Gynecol 2018; 218 (2S): S790-802.e1
    CrossrefPubMedGoogle Scholar
  • 8 Triunfo S, Crovetto F, Scazzocchio E, Parra-Saavedra M, Gratacos E, Figueras F. Contingent versus routine third-trimester screening for late fetal growth restriction. Ultrasound Obstet Gynecol 2016; 47 (01) 81-88
    CrossrefPubMedGoogle Scholar
  • 9 American Academy of Pediatrics. American College of Obstetricians and Gynecologists; Guidelines for perinatal care. Eighth edition. Accessed July 2, 2022, at: https://www.acog.org/clinical-information/physician-faqs/-/media/3a22e153b67446a6b31fb051e469187c.ashx
    Google Scholar
  • 10 Krans EE, Davis MM. Preventing low birthweight: 25 years, prenatal risk, and the failure to reinvent prenatal care. Am J Obstet Gynecol 2012; 206 (05) 398-403
    CrossrefPubMedGoogle Scholar
  • 11 Carter EB, Tuuli MG, Caughey AB, Odibo AO, Macones GA, Cahill AG. Number of prenatal visits and pregnancy outcomes in low-risk women. J Perinatol 2016; 36 (03) 178-181
    CrossrefPubMedGoogle Scholar
  • 12 Klerman LV, Ramey SL, Goldenberg RL, Marbury S, Hou J, Cliver SP. A randomized trial of augmented prenatal care for multiple-risk, Medicaid-eligible African American women. Am J Public Health 2001; 91 (01) 105-111
    CrossrefPubMedGoogle Scholar
  • 13 Abraham C. Rethinking the traditional prenatal care model. Obstet Gynecol 2020; 135 (05) 1024-1026
    CrossrefPubMedGoogle Scholar
  • 14 Peahl AF, Novara A, Heisler M, Dalton VK, Moniz MH, Smith RD. Patient preferences for prenatal and postpartum care delivery: a survey of postpartum women. Obstet Gynecol 2020; 135 (05) 1038-1046
    CrossrefPubMedGoogle Scholar
  • 15 McDuffie Jr. RS, Beck A, Bischoff K, Cross J, Orleans M. Effect of frequency of prenatal care visits on perinatal outcome among low-risk women. A randomized controlled trial. JAMA 1996; 275 (11) 847-851
    CrossrefPubMedGoogle Scholar
  • 16 Kern-Goldberger AR, Srinivas SK. Telemedicine in obstetrics. Clin Perinatol 2020; 47 (04) 743-757
    CrossrefPubMedGoogle Scholar
  • 17 Whittington JR, Ramseyer AM, Taylor CB. Telemedicine in low-risk obstetrics. Obstet Gynecol Clin North Am 2020; 47 (02) 241-247
    CrossrefPubMedGoogle Scholar
  • 18 Magann EF, McKelvey SS, Hitt WC, Smith MV, Azam GA, Lowery CL. The use of telemedicine in obstetrics: a review of the literature. Obstet Gynecol Surv 2011; 66 (03) 170-178
    CrossrefPubMedGoogle Scholar
  • 19 Long MC, Angtuaco T, Lowery C. Ultrasound in telemedicine: its impact in high-risk obstetric health care delivery. Ultrasound Q 2014; 30 (03) 167-172
    CrossrefPubMedGoogle Scholar
  • 20 Oken E, Kleinman KP, Rich-Edwards J, Gillman MW. A nearly continuous measure of birth weight for gestational age using a United States national reference. BMC Pediatr 2003; 3 (01) 6
    CrossrefPubMedGoogle Scholar
  • 21 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
    Google Scholar
  • 22 Gregory KD, Johnson CT, Johnson TRB, Entman SS. The content of prenatal care. Update 2005. Womens Health Issues 2006; 16 (04) 198-215
    PubMedGoogle Scholar
  • 23 Aziz A, Zork N, Aubey JJ. et al. Telehealth for high-risk pregnancies in the setting of the COVID-19 pandemic. Am J Perinatol 2020; 37 (08) 800-808
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 24 Barton JR, Saade GR, Sibai BM. A proposed plan for prenatal care to minimize risks of COVID-19 to patients and providers: focus on hypertensive disorders of pregnancy. Am J Perinatol 2020; 37 (08) 837-844
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 25 Implementing Telehealth in Practice. Implementing telehealth in practice: ACOG Committee Opinion Summary, number 798. Obstet Gynecol 2020; 135 (02) 493-494
    CrossrefPubMedGoogle Scholar
  • 26 Fratelli N, Valcamonico A, Prefumo F, Pagani G, Guarneri T, Frusca T. Effects of antenatal recognition and follow-up on perinatal outcomes in small-for-gestational age infants delivered after 36 weeks. Acta Obstet Gynecol Scand 2013; 92 (02) 223-229
    CrossrefPubMedGoogle Scholar
  • 27 Monier I, Blondel B, Ego A, Kaminiski M, Goffinet F, Zeitlin J. Poor effectiveness of antenatal detection of fetal growth restriction and consequences for obstetric management and neonatal outcomes: a French national study. BJOG 2015; 122 (04) 518-527
    CrossrefPubMedGoogle Scholar
  • 28 Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 2013; 13: 59
    CrossrefPubMedGoogle Scholar
  • 29 WHO Multicentre Growth Reference Study Group. WHO child growth standards based on length/height, weight and age. Acta Paediatr Suppl 2006; 450: 76-85
    CrossrefPubMedGoogle Scholar
  • 30 Pilliod RA, Cheng YW, Snowden JM, Doss AE, Caughey AB. The risk of intrauterine fetal death in the small-for-gestational-age fetus. Am J Obstet Gynecol 2012; 207 (04) 318.e1-318.e6
    CrossrefPubMedGoogle Scholar
  • 31 ACOG practice bulletin no. 202: gestational hypertension and preeclampsia. Obstet Gynecol 2019; 133 (01) e1-e25
    CrossrefPubMedGoogle Scholar
  • 32 American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. ACOG practice bulletin no. 203: chronic hypertension in pregnancy. Obstet Gynecol 2019; 133 (01) e26-e50
    CrossrefPubMedGoogle Scholar
  • 33 Fingar KR, Mabry-Hernandez I, Ngo-Metzger Q, Wolff T, Steiner CA, Elixhauser A. Delivery hospitalizations involving preeclampsia and eclampsia, 2005–2014: statistical brief #222. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville MD. Agency for Healthcare Research and Quality (US); 2006
    Google Scholar
  • 34 Todros T, Masturzo B, De Francia S. COVID-19 infection: ACE2, pregnancy and preeclampsia. Eur J Obstet Gynecol Reprod Biol 2020; 253: 330
    CrossrefPubMedGoogle Scholar