Original Article A survey of policies for the monitoring of fetal growth in Australian and New Zealand hospitals Kristen GIBBONS, 1 Michael BECKMANN, 2 Vicki FLENADY, 1,3 Dominique ROSSOUW, 1 Glenn GARDENER, 3,4 Kassam MAHOMED, 3,5 Peter H. GRAY 3,6 and Paul DEVENISH-MEARES 2 1 Mothers’ and Babies Health, Mater Medical Research Institute, South Brisbane, Queensland, 2 Department of Obstetrics and Gynaecology, Mater Mothers’ Hospital, South Brisbane, Queensland, 3 School of Medicine, University of Queensland, Brisbane, Queensland, 4 Mater Centre for Maternal Fetal Medicine, Mater Mothers’ Hospital, South Brisbane, Queensland, 5 Department of Obstetrics and Gynaecology, Ipswich Hospital, Ipswich, Queensland, and 6 Division of Neonatology, Mater Mothers’ Hospital, South Brisbane, Queensland, Australia Background: Fetal growth restriction is associated with increased perinatal mortality and morbidity and adverse developmental outcome. However, evidence is lacking on optimal approaches to antenatal screening of fetal size and growth. Aims: To determine the current policies and practices for assessment of fetal size and monitoring fetal growth with a view to informing future research in this area. Methods: Web-based survey of Directors of Obstetrics and Gynaecology in maternity hospitals with over 1000 births per annum in Australia and New Zealand (ANZ). The survey focussed on the existence and details of guidelines for the clinical assessment of fetal size and growth in low- and high-risk pregnancies, techniques utilised for clinical assessment of fetal size and growth and the use of birthweight charts. Results: Completed surveys were received from 49 (66%) of the 74 hospitals surveyed. Forty-four percent of hospitals have a fetal growth screening guideline, with abdominal palpation and symphysis fundal height (SFH) measurement the most common screening tools. Seventy-nine percent indicated that obstetric or birthweight charts were in use; 39% were unsure which chart ⁄ s were in use, and use differed by region. There was reasonable agreement regarding decision to take action following discrepancies between gestational age and SFH. Sixty-five percent of participants are interested in participating in a randomised controlled trial in this area. Conclusions: The survey revealed that while there is some agreement with respect to methods used in the clinical assessment of fetal size and growth, there is interest in ANZ hospitals to pursue this area of research further. Key words: antenatal screening, fetal growth, survey. Introduction Fetal growth monitoring is a critical component of antenatal care to detect fetuses that are either large or small for dates. Fetal growth restriction is associated with increased perinatal mortality 1,2 and morbidity 2 and adverse developmental outcome. 3,4 In addition, many of the fetuses defined as small-for-gestational-age (SGA) (usually defined as birthweight below the 10th centile) are constitutionally small and not growth restricted and do not need any intervention as they are not associated with adverse outcome (the converse is also true; fetal growth restriction can occur in fetuses that are not SGA and these too need to be identified for appropriate monitoring and possible intervention). Therefore we, need to be able to identify the fetus that is truly growth restricted to ensure we assess fetal well-being and plan timely delivery. Methods used to assess fetal growth include serial measurement of symphysis fundal height (SFH) and ultrasound biometry with estimation of fetal weight. The majority of these techniques can be used in conjunction with some type of birthweight chart. Traditionally, population- based gender-specific birthweight charts have been used to plot fetal growth over the course of the pregnancy. 5,6 As an alternative, customised birthweight charts can be used, 7 taking into account those maternal factors which influence a baby’s size (such as age, body mass index (BMI) and parity). Both population-based and customised birthweight charts are generally used in conjunction with SFH measurement ⁄ s Correspondence: Mrs Kristen Gibbons, Mater Medical Research Institute, Level 3 Quarters Building, Annerley Road, Woolloongabba, QLD 4102, Australia. Email: kgibbons@mmri.mater.org.au There are no conflicts of interest. Received 24 January 2011; accepted 8 July 2011. Ó 2011 The Authors 493 Australian and New Zealand Journal of Obstetrics and Gynaecology Ó 2011 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists Australian and New Zealand Journal of Obstetrics and Gynaecology 2011; 51: 493–498 DOI: 10.1111/j.1479-828X.2011.01354.x e Australian and New Zealand Journal of Obstetrics and Gynaecology