Building on their discovery last year that is re-writing the rule books on care of babies in the womb, Irish researchers have developed the first Irish Clinical Practice Guidelines on Fetal Growth Restriction.  The guidelines will be published today, 6 March, at a major national obstetric meeting  at the Rotunda Hospital to present the latest studies from the HRB Perinatal Ireland Network*.

The new guidelines are informed by a recent study which examined 1,100 babies experiencing growth restriction in the womb. The aim was to establish exactly when health professionals need to intervene to prevent serious health complications for a small baby.

Dr Julia Unterscheider, lead researcher on the study and RCSI Fellow in Maternal Fetal Medicine explains, ‘Distinguishing between small, but normal, babies and small at-risk babies is one of the most common, controversial and complex problems in current maternity care. Standard international practice had been to consider those babies in the bottom 10% by weight to be at the highest risk of developing complications. These mothers and babies usually receive increased surveillance and monitoring.  However, our study questions whether this is necessary for all cases. ‘Our research found that the majority of babies whose weight falls into the bottom 10% from a weight perspective go on to be a healthy baby that is simply small for its gestational age.   We discovered that the highest risk for adverse outcomes are in the group of babies that fall into the bottom three per cent by weight and who have an abnormal reading on a particular ultrasound test. It is this group that need the special monitoring or intervention. ‘We developed these new guidelines to help standardise and improve antenatal care of pregnancies affected by Fetal Growth Restriction based on the best evidence available. They will be a great resource for obstetricians, trainees and midwives working in Ireland, but may also be useful for women and their partners, GPs and commissioners of health care’.


Dr Mairead O Driscoll, Director of Research Strategy and Funding at the Health Research Board (HRB) says,
‘It is great to see research we have funded being translated into practice so quickly. These new guidelines provide health professionals with appropriate and accurate interventions which will help improve survival rates and outcomes for small babies and hopefully reduce stress among mothers-to-be. It will also ensure resources are used in the most effective way’.


Professor Fergal Malone, Chairman of Perinatal Ireland, Consultant Obstetrician and Gynaecologist at the Rotunda and RCSI Professor of Obstetrics & Gynaecology says, 
‘The critical advantage of the HRB Perinatal Ireland network is that it has given us access to large patient populations which has transformed our ability to do Perinatal research here.  These guidelines are a testament to this, but also to the spirit of collaboration that exists amongst Irish obstetricians who are now working together on a range of research projects to advance the health of mothers and their babies. This research network has the potential to radically change the focus and intensity of current assessment for at risk pregnancies’.


Prof Michael Turner, UCD Professor in Obstetrics and Gynaecology at the Coombe Hospital and HSE National Director for Obstetrics and Gynaecology says,
‘Worldwide it is estimated that only one third of growth restricted babies are properly identified. These guidelines will enable clinicians to really focus on antenatal care appropriately and the research will hopefully have a global impact on improving maternal and neonatal care’.
Professor Fionnuala McAuliffe, Institute of Obstetricians and Gynaecologists adds,
‘These guidelines are important and will act as an informative resource in the management of the small baby in the womb.’

Case Study

Grainne Foley was one of the mothers involved in the study. Her son John was accurately diagnosed with fetal growth restriction and born 11 weeks premature weighing just 2lbs and 6 ounces. He is now a healthy two year old boy. She will present the parents perspective of being involved in a study at the Perinatal Ireland event.
According to Grainne,
‘Taking part in the study was a bit of a no-brainer really. Knowing that there was potential for some difficulties was a real worry for me. But it was very reassuring and eased the stress knowing I was able to avail of all the expert advice, ongoing monitoring and surveillance that the research team brought to the hospital. I now have a healthy, and happy, two-year-old’.
For more information please contact:
Dr. Liz Tully, Programme Manager, Perinatal Ireland


New Irish guidelines will protect small babies in the womb
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