{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T22:11:21Z","timestamp":1783462281792,"version":"3.55.0"},"reference-count":40,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2024,11,8]],"date-time":"2024-11-08T00:00:00Z","timestamp":1731024000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,11,8]],"date-time":"2024-11-08T00:00:00Z","timestamp":1731024000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec>\n                    <jats:title>Aim:<\/jats:title>\n                    <jats:p>Growth Assessment Protocol is a fetal growth initiative designed to improve antenatal detection of babies who are small-for-gestational-age and reduce stillbirths. However, its direct impact on pregnancy outcome and stillbirth rates is questioned. This service evaluation aimed to assess Growth Assessment Protocol\u2019s influence on pregnancy outcomes at a National Health Service hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method:<\/jats:title>\n                    <jats:p>Anonymous, maternity and ultrasound data, routinely acquired between 2014 and 2022 were extracted from clinical databases (Viewpoint, Euroking). Trends in maternity data and ultrasound scan volume were explored with descriptive statistics. Variables of stillbirth, antenatal small-for-gestational-age detection and scan volume were compared before and after Growth Assessment Protocol implementation. Associations between these variables were evaluated using Spearman\u2019s rho.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The percentage of babies born small-for-gestational-age reduced by 0.3% across the evaluation period. Antenatal small-for-gestational-age diagnosis rose from 4.1% to 14.3%. However, the number of false-positive cases of antenatally diagnosed small-for-gestational-age increased fivefold from 2.2% to 11.5%. Although stillbirth rates remained consistent post-Growth Assessment Protocol, complex scan volume (e.g. number of growth scans using Doppler) increased annually. The peak incline coincided with the Growth Assessment Protocol implementation period (2016\u20132018). Complex scan volume was significantly associated with overall small-for-gestational-age detection (rho = 0.8,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      =&lt; 0.001), but not with stillbirth frequency (rho = \u22120.1,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.4).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Small-for-gestational-age detection increased following Growth Assessment Protocol implementation, although this was associated with a high false-positive rate and no reduction in stillbirths. The potential implications associated with clinical management, parent experiences and departmental workflow, alongside the benefits for stillbirth reduction, should be fully considered prior to the introduction of a new fetal growth initiative to the antenatal care pathway.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1742271x241287925","type":"journal-article","created":{"date-parts":[[2024,11,8]],"date-time":"2024-11-08T23:55:52Z","timestamp":1731110152000},"page":"91-100","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["The effect of an enhanced fetal growth ultrasound protocol on pregnancy outcomes: A retrospective service evaluation within a single UK National Health Service centre between 2014 and 2022"],"prefix":"10.1177","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8164-5053","authenticated-orcid":false,"given":"Eleanor","family":"Butterfield","sequence":"first","affiliation":[{"name":"Frimley Health NHS Foundation Trust, Frimley, UK"},{"name":"School of Health and Psychological Sciences, City, University of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0132-7948","authenticated-orcid":false,"given":"Emily","family":"Skelton","sequence":"additional","affiliation":[{"name":"School of Health and Psychological Sciences, City, University of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,11,8]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"NHS. Overview stillbirth 2024 https:\/\/www.nhs.uk\/conditions\/stillbirth\/ (accessed 18 March 2024)."},{"key":"e_1_3_3_3_2","unstructured":"NHS England. Saving babies\u2019 lives: a care bundle for reducing stillbirth 2016 https:\/\/www.england.nhs.uk\/wp-content\/uploads\/2016\/03\/saving-babies-lives-car-bundl.pdf (accessed 7 March 2023)."},{"key":"e_1_3_3_4_2","unstructured":"Royal College of Obstetricians Gynaecologists. The investigation and management of the small-for-gestational-age fetus. Green-top Guideline No.31 2014 https:\/\/www.rcog.org.uk\/media\/t3lmjhnl\/gtg_31.pdf (accessed 12 January 2023)."},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/uog.22187"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20414"},{"key":"e_1_3_3_7_2","unstructured":"National Institute for Health Care Excellence. Antenatal care NICE guideline 2021 https:\/\/www.nice.org.uk\/guidance\/ng201\/resources\/antenatal-care-pdf-66143709695941 (accessed 8 March 2023)."},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2017.11.593"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/uog.22134"},{"key":"e_1_3_3_10_2","unstructured":"Centre for maternal and child enquiries. Perinatal mortality 2008 https:\/\/www.publichealth.hscni.net\/sites\/default\/files\/Perinatal%20Mortality%202008.pdf (July 2010 accessed 1 March 2023)."},{"key":"e_1_3_3_11_2","unstructured":"Perinatal Institute. 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Timeline of UK government coronavirus lockdowns and measures March 2020 to December 2021 2021 https:\/\/www.instituteforgovernment.org.uk\/sites\/default\/files\/timeline-coronavirus-lockdown-december-2021.pdf (accessed 20 June 2023)."},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2021.03.004"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.12746"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-04898-5"},{"key":"e_1_3_3_22_2","unstructured":"Office for National Statistics. Deaths registered in England and Wales: 2021 (refreshed populations) \u2013 Office for National Statistics https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/birthsdeathsandmarriages\/deaths\/datasets\/deathsregisteredinenglandandwales2021refreshedpopulations (27 January 2023 accessed 28 February 2023)."},{"key":"e_1_3_3_23_2","unstructured":"National Records of Scotland. Births Deaths and Other Vital Events \u2013 Quarterly figures 2022 https:\/\/webarchive.nrscotland.gov.uk\/20221027024212\/https:\/\/www.nrscotland.gov.uk\/statistics-and-data\/statistics\/statistics-by-theme\/vital-events\/general-publications\/births-deaths-and-other-vital-events-quarterly-figures\/4th-quarter-2021 (accessed 16 May 2023)."},{"key":"e_1_3_3_24_2","unstructured":"Perinatal Institute. 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