Standardizing Fetal Growth Assessment for Improved Patient Care
The SOON Consensus Working Group focuses on conducting large-scale research, quality improvement, and standardizing care in fetal growth assessment. With a mission to address the wide variation among centers, the group aims to enhance patient care by standardizing the measurement and interpretation of fetal growth parameters. By focusing on key factors such as biometric indices, fetal weight estimation models, and growth charts, the group seeks to minimize the risks of over- or under-diagnosing fetal growth abnormalities. Collaborating across disciplines, the group plans to revolutionize how fetal growth is assessed, leading to better outcomes and reduced uncertainties in clinical practice.
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SOON Consensus Working Group on Fetal Growth Introduction May-1st, 2019
Goals: 1. Conduct large scale research 2. Quality improvement 3. Standardize care based on the best available evidence Improving patient care Fetal Growth Assessment
Why Fetal Growth Assessment? 1. Frequently used- (Sunnybrook 2018: 8390 EFWs - ~150/wk, ~30/d) 2. Important consequences Resources Interventions 3. New charts became available 4. Wide variation among SOON centers
Variation in growth chart within SOON Hadlock Kramer X X X McMaster Medical Centre (switch to IG21?) X X X Site IG21 Doubilet Sunnybrook SMH MSH McMaster ? St Joseph s Healthcare Hamilton NYGH RVH Credit Valley Mckenzie St. Joseph s Michael Garron Scarborough (all sites) RR Imaging True North Imaging X X X X X X Why is this a problem? 1. Over- & under-diagnosis of FGR/LGA 2. Miscommunication COMMON GOAL to standardize fetal growth assessment
What do we want to standardize? Need/timing of 3rd trimester growth assessment Measuring fetal biometric indices BPD? AC? Interpretation of individual biometric indices Model used for estimation of fetal weight Growth chart used for interpretation of EFW Growth chart for twins? Doppler (UA, MCA/CPR, UtA) indication? Which GA? Diagnosis of FGR which percentile cut-off to use - 10%? 5%?
What do we want to standardize? Need/timing of 3rd trimester growth assessment Measuring fetal biometric indices BPD? AC? Interpretation of individual biometric indices Model used for estimation of fetal weight Growth chart used for interpretation of EFW Growth chart for twins? Doppler (UA, MCA/CPR, UtA) indication? Which GA? Diagnosis of FGR which percentile cut-off to use - 10%? 5%?
How do we plan to do it? MFM (15) Radiology (5) Jon Barrett Phyllis Glanc Nir Melamed Ori Nevo Howard Berger John Kingdom Ants Toi Greg Ryan Ida Khalili Han Keunen Nan Okun Nimrah abassi Clare Whitehead Sarah McDonalds Patrick Mohide Bryon DeFrance Elad Mei-Dan Hani Akoury Rebecca Menzies Rose Rahmani Rose Lee, Sharon Shin Site (9) Sunnybrook Neonatology (2) Elizabeth Asztalos OB Medicine SMH MSH Joel Ray Prakesh Shah McMaster NYGH St. Joseph s Credit Valley RR Imaging North Imaging 2. Present the recommendations in the next SOON meeting 3. SOON representatives to take to local U/S units high compliance is likely 4. SOON will support local U/S units with information, online tools 5. Submit to JOGC process, recommendations
How to reach a consensus? A consensus means that everyone agrees to say collectively what no one believes individually Abba Eban
How to reach a consensus? Key principles 1. Shared goal 2. No clear answer Present the data Open interactive discussion, brain storming Understand rationale, concerns of different centers Collect ideas/suggestions, ?additional data Goal: Find solutions that everyone actively support, or at least can live with Consensus may not be achieved
Agenda for meeting #1 (May-1st, 2019) 18:00-18:15 Gathering 18:15-18:20 Welcome (Jon) 18:20-18:30 Introduction (Nir) 18:30-18:45 The choice of sEFW model (Nimrah) 18:45-19:00 Discussion 19:00-19:20 The choice of growth chart (Clare) 19:20-19:50 Performance of charts in our in local population (Nir) 19:50-20:50 Discussion 20:50-21:00 Summary and next steps
