{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T16:53:40Z","timestamp":1783443220840,"version":"3.54.6"},"reference-count":21,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,12,19]],"date-time":"2020-12-19T00:00:00Z","timestamp":1608336000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aust NZ J Obst Gynaeco"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Timely detection of small for gestational age (SGA) fetuses is important for reducing severe perinatal morbidity and mortality, and better tools are needed to detect SGA in maternity care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>We evaluated the effect of the introduction of the Perinatal Institute\u2019s Growth Assessment Protocol (GAP) in the Counties Manukau Health region, South Auckland, New Zealand, on antenatal detection of SGA and maternal and perinatal outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>Uncontrolled before and after study in women booked under hospital community midwife care with a singleton, non\u2010anomalous pregnancy. Antenatal detection of SGA (birthweight &lt;10th customised centile) was compared pre\u2010GAP (2012, <jats:italic>N<\/jats:italic>\u00a0=\u00a01105) and post\u2010GAP (2017, <jats:italic>N<\/jats:italic>\u00a0=\u00a01082). Composite adverse neonatal outcome was defined as neonatal unit admission &gt;48\u00a0h, five\u2010minute Apgar score &lt;7, and\/or any ventilation. Analyses were adjusted for maternal age, body mass index, deprivation, smoking and ethnicity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>SGA rates were similar across epochs (13.8% vs 12.9%) but antenatal detection of SGA increased from 22.9% (35\/153) to 57.9% (81\/140) post\u2010GAP (adjusted odds ratio (aOR)\u00a0=\u00a04.8, 95% CI 2.82\u20138.18). Rates of induction of labour and caesarean section increased between epochs but were similar in SGA, non\u2010SGA, and detected and non\u2010detected SGA subgroups. Among SGA babies, there was some evidence that antenatal detection of SGA may be associated with lower composite adverse neonatal outcome (detected SGA: aOR 0.44 95% CI 0.17\u20131.15; non\u2010detected SGA: aOR\u00a0=\u00a01.81 95% CI 0.73\u20134.48; interaction <jats:italic>P<\/jats:italic>\u00a0=\u00a00.03). Pre\u2010term birth did not appear to be influenced by GAP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Implementation of GAP was associated with a nearly five\u2010fold increase in SGA detection without increasing obstetric intervention for SGA.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ajo.13283","type":"journal-article","created":{"date-parts":[[2020,12,20]],"date-time":"2020-12-20T03:43:50Z","timestamp":1608435830000},"page":"339-346","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Detection of small for gestational age babies and perinatal outcomes following implementation of the Growth Assessment Protocol at a New Zealand tertiary facility: An observational intervention study"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7181-6176","authenticated-orcid":false,"given":"F. Joyce","family":"Cowan","sequence":"first","affiliation":[{"name":"Department of Midwifery Auckland University of Technology Auckland New Zealand"},{"name":"Perinatal Institute Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J. D.","family":"McKinlay","sequence":"additional","affiliation":[{"name":"Liggins Institute Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand"},{"name":"Kidz First Neonatal Care Counties Manukau Health Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rennae S.","family":"Taylor","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Faculty of Medical and Health Sciences The University of Auckland Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jess","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Faculty of Medical and Health Sciences The University of Auckland Auckland New Zealand"},{"name":"Department of Paediatrics: Child and Youth Health Faculty of Medical and Health Sciences Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"McAra\u2010Couper","sequence":"additional","affiliation":[{"name":"Department of Midwifery Auckland University of Technology Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Garrett","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Epidemiology Auckland University of Technology Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"O\u2019Brien","sequence":"additional","affiliation":[{"name":"Health Intelligence and Informatics Counties Manukau Health Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9915-7873","authenticated-orcid":false,"given":"Lesley M. E.","family":"McCowan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Faculty of Medical and Health Sciences The University of Auckland Auckland New Zealand"},{"name":"South Auckland Clinical School Middlemore Hospital Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,12,19]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60064-0"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.1806"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f108"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2019.03.014"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2017.12.011"},{"key":"e_1_2_6_7_1","first-page":"516","article-title":"The growth assessment protocol: a national programme to improve patient safety in maternity care","volume":"23","author":"Clifford S","year":"2013","journal-title":"MIDIRS"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajo.12016"},{"issue":"509","key":"e_1_2_6_9_1","first-page":"e1","article-title":"INTERGROWTH\u201021st vs customized birthweight standards for identification of perinatal mortality and morbidity","volume":"214","author":"Anderson NH","year":"2016","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41372-020-0631-3"},{"issue":"003942","key":"e_1_2_6_11_1","first-page":"1","article-title":"Association between reduced stillbirth rates in England and regional uptake of accreditation training in customised fetal growth assessment","volume":"3","author":"Gardosi J","year":"2013","journal-title":"BMJ Open"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajo.12902"},{"key":"e_1_2_6_13_1","unstructured":"PMMRC.Twelfth Annual Report of the Perinatal and Maternal Mortality Review Committee: Reporting Mortality 2016.Wellington:Health Quality & Safety Commission 2018. 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