Statement | Answer | Midwife-led Care | Obstetrician-led Care | Consensus total group |
---|---|---|---|---|
n (%) | n (%) | |||
2.1. An ultrasound biometry and assessment of amniotic fluid volume is to be repeated immediately after referral to obstetrician-led care, even if this is within 2Ā weeks of the previous scan (in midwife-led care). | A | 12 (60%) | 20 (80%) | No consensus |
D | 8 (40%) | 5 (20%) | ||
N | 3 | 1 | ||
M | 4 | 3 | ||
2.2. As fetal growth can only be evaluated through serial measurements, we will advise to plot EFW on the CGC in obstetrician-led care as well (as in midwife-led care). We will also advise to be alert for asymmetrical growth based on the ratios of AC, FL, BPD and HC. | A | 23 (100%) | 20 (80%) | Consensus: agree |
D | 0 | 5 (20%) | ||
N | 0 | 2 | ||
M | 4 | 2 | ||
2.3. In obstetrician-led care, decreased amniotic fluid volume should be defined using the same cut-off values as in midwife-led care. | A | 23 (100%) | 24 (96%) | Consensus: agree |
D | 0 | 1 (4%) | ||
N | 0 | 1 | ||
M | 4 | 3 | ||
2.4. Suspicion of IUGR is an indication for measuring the umbilical artery Doppler in obstetrician-led care. Which measurement is the first abnormal sign for fetal deterioration? (multiple options) | Pulsatility Index (PI) | 10 (91%) | 23 (92%) | Consensus: Pulsatility Index (PI) No consensus on the other answers |
Resistance Index (RI) | 4 (36%) | 0 | ||
Absent diastolic flow | 2 (18%) | 20 (80%) | ||
Reversed diastolic flow | 3 (27%) | 18 (72%) | ||
Other | 0 | 0 | ||
N | 16 | 0 | ||
M | 0 | 4 | ||
2.5. A PI of the umbilical artery Doppler ā„ P95 is abnormal (and management of pregnancy should be adjusted). | A | 11 (92%) | 24 (96%) | Consensus: agree |
D | 1 (8%) | 1 (4%) | ||
N | 11 | 1 | ||
M | 4 | 3 | ||
2.6. In the IRIS study it will be advised to assess the PI of the middle cerebral artery Doppler when IUGR is suspected. | A | 10 (100%) | 21 (88%) | Consensus: agree |
D | 0 | 3 (12%) | ||
N | 13 | 3 | ||
M | 4 | 2 | ||
2.7. The ductus venosus Doppler should be measured when IUGR is suspected. | A | 5 (83%) | 6 (46%) | No consensus |
D | 1 (17%) | 7 (54%) | ||
N | 17 | 13 | ||
M | 4 | 3 | ||
2.8. In the IRIS study we will recommend a FAS in case of IUGR, if not previously performed. | A | 22 (100%) | 24 (89%) | Consensus: agree |
D | 0 | 3 (11%) | ||
N | 1 | 0 | ||
M | 4 | 2 | ||
2.9. At which degree of IUGR, defined by centiles of EFW on the CGC, should a FAS be offered to the pregnant woman? | ā¤ P5 | 12 (60%) | 12 (50%) | No consensus |
ā¤ P2.3 | 7 (35%) | 10 (42%) | ||
Degree of IUGR is not relevant for the assessment of fetal anatomical anomalies | 1 (5%) | 2 (8%) | ||
N | 3 | 3 | ||
M | 4 | 2 | ||
2.10. A FAS because of suspected IUGR, should be performed by: | A sonographer in secondary care, who is trained for FAS. Depending on the results, referral for advanced sonography in tertiary care will take place | 11 (55%) | 6 (22%) | No consensus |
An obstetric ultrasound specialist, trained for advanced sonography (under the responsibility of tertiary care) | 9 (45%) | 21 (78%) | ||
N | 3 | 0 | ||
M | 4 | 2 | ||
2.11. In the IRIS study, in case of suspicion of IUGR, it will be advised not to commence CTG monitoring as long as there is no decrease in fetal movements nor a hypertensive disorder and no abnormal Doppler profiles. | A | 18 (90%) | 23 (85%) | Consensus: agree |
D | 2 (10%) | 4 (15%) | ||
N | 3 | 0 | ||
M | 4 | 2 | ||
2.12. At which degree of IUGR, defined by centiles of EFW on the CGC, should assessment for specific fetal infections be advised? | < P10 | 2 (12%) | 1 (4%) | No consensus |
< P5 | 5 (29%) | 7 (27%) | ||
< P2.3 | 10 (59%) | 16 (61%) | ||
At another P-value | 0 | 2 (8%) | ||
N | 6 | 1 | ||
M | 4 | 2 | ||
2.13. Gestational age, in addition to degree of IUGR, determines whether one should check for specific fetal infections | A | 2 (12%) | 4 (16%) | Consensus: disagree |
D | 15 (88%) | 21 (84%) | ||
N | 8 | 1 | ||
M | 2 | 3 | ||
2.14. If fetal infections are to be checked for because of suspicion of IUGR than test for: Coxsackie Virus | A | 3 (14%) | 0 | Consensus: disagree |
D | 18 (86%) | 23 (100%) | ||
N | 6 | 2 | ||
M | 0 | 4 | ||
Cytomegalovirus | A | 19 (90%) | 20 (87%) | Consensus: agree |
D | 2 (10%) | 3 (13%) | ||
N | 6 | 2 | ||
M | 0 | 4 | ||
Malaria | A | 1 (5%) | 0 | Consensus: disagree |
D | 20 (95%) | 23 (100%) | ||
N | 6 | 2 | ||
M | 0 | 4 | ||
Toxoplasmosis | A | 17 (100%) | 19 (76%) | Consensus: agree |
D | 0 | 6 (24%) | ||
N | 6 | 1 | ||
M | 4 | 3 | ||
Rubella | A | 14 (88%) | 11 (55%) | No consensus |
D | 2 (12%) | 9 (45%) | ||
N | 7 | 6 | ||
M | 4 | 3 | ||
Herpes | A | 13 (100%) | 12 (55%) | No consensus |
D | 0 | 10 (45%) | ||
N | 10 | 4 | ||
M | 4 | 3 | ||
Parvo B19 | A | 18 (100%) | 14 (70%) | Consensus: agree |
D | 0 | 6 (30%) | ||
N | 5 | 6 | ||
M | 4 | 3 | ||
Syphilis | A | 11 (79%) | 8 (40%) | No consensus |
D | 3 (21%) | 12 (60%) | ||
N | 9 | 6 | ||
M | 4 | 3 | ||
2.15. In the IRIS study, offering invasive prenatal testing will not be advised routinely in case of IUGR; but rather individual risk factors and gestational age should be considered. | A | 22 (100%) | 25 (93%) | Consensus: agree |
D | 0 | 2 (7%) | ||
N | 1 | 0 | ||
M | 4 | 2 | ||
2.16. In the IRIS study, invasive prenatal testing will be offered to the couple if the EFWĀ ā¤Ā P2.3. | A | 18 (95%) | 23 (85%) | Consensus: agree |
D | 1 (5%) | 4 (15%) | ||
N | 4 | 0 | ||
M | 4 | 2 |