{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T03:35:31Z","timestamp":1782272131813,"version":"3.54.5"},"reference-count":31,"publisher":"Walter de Gruyter GmbH","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,7,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec id=\"j_jpm-2022-0111_abs_001\">\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>India has a high rate of stillbirths, and many deaths are due to fetal growth restriction and potentially preventable. Screening and identification of the small for gestational age (SGA) fetus during the antenatal period has been shown to reduce stillbirths. We set out to evaluate the impact of implementing the Growth Assessment Protocol (GAP), a programme designed for screening for SGA.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpm-2022-0111_abs_002\">\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Observational study comparing two-time epochs; before (years 2011\u20132014) and after (years 2015\u20132018) introduction of GAP. The programme includes identification of risk factors, risk categorization, serial fundal height measurement, customised fetal growth charts and appropriate referral protocols. Fetal growth charts and birth centiles were generated based on the hospital database of normal outcome pregnancies, customised to women\u2019s ethnicity, parity, height, and weight. The protocol was introduced following training of obstetric and midwifery care providers. We evaluated SGA detection rates, stillbirth rates (from 28\u00a0weeks) and neonatal morbidity at term.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpm-2022-0111_abs_003\">\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>There were 26,199 and 31,498 births, with 115 and 108 stillbirths in the pre and post-GAP implementation periods, respectively. SGA detection rates increased from 51.1 to 67.1%, representing a 31% improvement (p&lt;0.001). Overall stillbirth rates declined from 4.4 to 3.4 per 1000 births (RR 0.78 CI 95% 0.60\u20131.02) and at term from 1.5 to 0.6 (RR 0.37 CI 95% 0.20\u20130.66). Neonatal intensive care admission and neonatal encephalopathy in term neonates also decreased significantly.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpm-2022-0111_abs_004\">\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Introduction of the GAP programme in an Indian tertiary maternity service was associated with improved antenatal detection of SGA and reduced stillbirth rates and neonatal morbidity.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1515\/jpm-2022-0111","type":"journal-article","created":{"date-parts":[[2022,6,11]],"date-time":"2022-06-11T03:35:27Z","timestamp":1654918527000},"page":"729-736","source":"Crossref","is-referenced-by-count":14,"title":["Impact of introduction of the growth assessment protocol in a South Indian tertiary hospital on SGA detection, stillbirth rate and neonatal outcome"],"prefix":"10.1515","volume":"50","author":[{"given":"Pallavi Chandra","family":"Ravula","sequence":"first","affiliation":[{"name":"Consultant, Department of Obstetrics , Fernandez Foundation , Hyderabad , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sridevi","family":"Veluganti","sequence":"additional","affiliation":[{"name":"Obstetric registrar, Department of Obstetrics , Fernandez Foundation , Hyderabad , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murali Mohan Reddy","family":"Gopireddy","sequence":"additional","affiliation":[{"name":"Consultant Epidemiologist , Evidencian Research Associates , Bangalore , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuzhat","family":"Aziz","sequence":"additional","affiliation":[{"name":"Consultant, Department of Obstetrics , Fernandez Foundation , Hyderabad , India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2022,6,13]]},"reference":[{"key":"2023033123434446314_j_jpm-2022-0111_ref_001","doi-asserted-by":"crossref","unstructured":"Hug, L, You, D, Blencowe, H, Mishra, A, Wang, Z, Fix, MJ, et\u00a0al. Global, regional, and national estimates and trends in stillbirths from 2000 to 2019: a systematic assessment. Lancet 2021;398:772\u201385. https:\/\/doi.org\/10.1016\/S0140-6736(21)01112-0.","DOI":"10.1016\/S0140-6736(21)01112-0"},{"key":"2023033123434446314_j_jpm-2022-0111_ref_002","doi-asserted-by":"crossref","unstructured":"Blencowe, H, Cousens, S, Jassir, FB, Say, L, Chou, D, Mathers, C, et\u00a0al. National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis. Lancet Global Health 2016;4:e98\u2013108. https:\/\/doi.org\/10.1016\/S2214-109X(15)00275-2.","DOI":"10.1016\/S2214-109X(15)00275-2"},{"key":"2023033123434446314_j_jpm-2022-0111_ref_003","doi-asserted-by":"crossref","unstructured":"Lawn, JE, Blencowe, H, Waiswa, P, Amouzou, A, Mathers, C, Hogan, D, et\u00a0al. Stillbirths: rates, risk factors, and acceleration towards 2030. 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