title: Care-related factors associated with antepartal diagnosis of intrauterine growth restriction: a case-control study.
abstract: BACKGROUND
  Antenatal care is of core importance for maternal and child health and is therefore a central aspect of mother and child health care. One of the main goals of effective screening in antenatal care is the detection of suboptimal fetal growth. However, the sensitivity of antenatal diagnostic of suboptimal fetal growth (i.e. intrauterine growth restriction; IUGR) through clinical routine fetal ultrasonography has been observed to be low. A study conducted in Germany found that only 30% of IUGR cases and 40% of congenital malformations were diagnosed antenatally. Reasons for this low detection rate remain unclear.
  
  
  METHODS
  In the first of two study components, all mothers who delivered or will deliver a small for gestational age (SGA) newborn in one of three hospitals in Bremen (Germany) during recruitment phase are eligible for inclusion in a hospital based case-control study. Cases are defined as neonates with an IUGR that was not detected antenatally, while controls are defined as neonates whose IUGR was identified or at least suspected antenatally. Data collection instruments include a newborn documentation sheet, a standardized, computer-assisted personal interview with mothers, and a copy of pregnancy record books. The second component is a survey among all private practice-based gynecologists in the federal states of Bremen and Lower Saxony. The aim of this survey was to obtain detailed information e.g. on quality of ultrasonography equipment and examiner's ultrasonography experience and qualification level.
  
  
  CONCLUSIONS
  To our knowledge, this is one of the few German studies explicitly addressing care-related as well as maternal-related factors influencing the (non-) detection of IUGR by conducting comprehensive interviews with mothers and private practice-based gynecologists. Over the last 15 years there have been substantial technological advances in ultrasonography equipment in gynecological practices; hence there is the need to evaluate whether the detection rates of IUGR in Germany are still as low as previously reported in the late 1990ies. Our study results will contribute to a better understanding of core risk factors for low early detection rates of intrauterine growth restrictions and may support quality development in this important health care sector.
authors.forename: Sinja Alexandra
authors.initials: SA
authors.lastname: Ernst
authors.forename: Anna
authors.initials: A
authors.lastname: Reeske
authors.forename: Jacob
authors.initials: J
authors.lastname: Spallek
authors.forename: Knud
authors.initials: K
authors.lastname: Petersen
authors.forename: Tilman
authors.initials: T
authors.lastname: Brand
authors.affiliation: Department of Prevention and Evaluation, Leibniz-Institute for Prevention Research and Epidemiology-BIPS, Achterstraße 30, Bremen, 28359, Germany. zeeb@bips.uni-bremen.de.
authors.forename: Hajo
authors.initials: H
authors.lastname: Zeeb
mesh_terms: D016022:Case-Control Studies; D002983:Clinical Competence; D005188:False Negative Reactions; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging*; D005858:Germany; D006176:Gynecology / Q000592:standards*; D006801:Humans; D007407:Interviews as Topic; D009035:Mothers; D011247:Pregnancy; D011295:Prenatal Care; D012107:Research Design; D016216:Ultrasonography, Prenatal / Q000295:instrumentation