The burden and neonatal outcomes of small for gestational age and restricted born in the public system of Jundiaí: Can performance indicators and neonatal outcomes help improve care?

• Grant number: 23/07720-0
• Support Opportunities: Regular Research Grants
• Start date: November 01, 2023
• End date: October 31, 2024
• Field of knowledge: Health Sciences - Medicine - Maternal and Child Health
• Principal Investigator: Renato Teixeira Souza
• Grantee: Renato Teixeira Souza
• Host Institution: Faculdade de Medicina de Jundiaí (FMJ). Prefeitura Municipal de Jundiaí. Jundiaí , SP, Brazil
• Associated researchers: Cristiano Torezzan ; José Guilherme Cecatti ; Juliana Ramos Nunes ; Matias Costa Vieira ; Rafael Bessa de Freitas Galvão ; Ricardo da Sillva Santos ; Ricardo Porto Tedesco ; Rodolfo de Carvalho Pacagnella ; Vanessa Mello da Silva

Abstract

Fetal growth restriction is defined as the "inability of the fetus during gestation to reach its growth potential", is pathological and can be reflected by an estimated fetal weight below the 3rd percentile for gestational age, significant drop in weight gain and/or hemodynamic alterations of the fetoplacental circulation. Small for gestational age fetuses are those whose weight is below the 10th percentile for gestational age and sex. Growth-restricted and small-for-gestational-age fetuses are known to have a worse neonatal outcome, associated with a higher risk of complications than fetuses with adequate weight for gestational age. In this regard, international guidelines recommend offering pregnancy termination at 37 weeks gestation for restricted fetuses and by the end of 39 weeks gestation for small for gestational age fetuses. Timely delivery is therefore crucial in reducing adverse events, but can only be offered if this condition is identified in a timely manner. Objective: To evaluate the performance related to timely resolution of pregnancies with small for gestational age and/or fetal growth restriction fetuses and the perinatal outcomes of women from the public service of Jundiaí. Method: Retrospective cohort study to be carried out among pregnant women treated at the University Hospital of Jundiaí (HU), São Paulo, including cases from the last 44 months prior to the start of the study. Cases of women from Jundiaí hospitalized by the SUS at the HU will be identified. Due to the period considered for the inclusion of cases (months prior to the start of the study), we do not expect women who gave birth at the institution to still be undergoing prenatal care or childbirth/postpartum care. Furthermore, as this is a retrospective study with data collection from patient records, we will request a waiver of informed consent since we will not be able to contact the patients involved. Maternal and neonatal data, including those about pregnancy, childbirth, and the puerperium, will be collected from the medical record. Ultrasound data will be extracted from the report information to a data spreadsheet through a natural language processing system. We will calculate the proportion of women with SGA or restricted newborn who delivered at 40 and 38 weeks or more, respectively; the proportion of medical indication in the resolution of the pregnancy of SGA or restricted newborns (induction or elective cesarean section by medical indication); and we will evaluate the perinatal morbidity and mortality of cases of SGA and restricted newborns. Expected Results: this study will provide indicators related to the performance of the public service in Jundiaí in providing timely delivery in cases of SGA and restricted newborns, which can help to improve antenatal care; indirectly, this may be crucial information to inform policies to reduce stillbirths and related complications. Also, a automatized system that can extract data from ultrasound reports and medical records can improve strategies to perform serial audition of the indicators. (AU)