Sam Mathewlynn

My Topol fellowship problem / project:

Antenatal care planning is a cornerstone of current obstetric practice, and there are several points in a woman’s pregnancy at which risk assessments are undertaken and plans made accordingly. The number of guidelines and recommendations that must be considered means it can be difficult to ensure that risk factors are not missed, and that recommended management plans are made correctly. Failure to identify a risk factor and plan accordingly can have devastating consequences for mothers and babies. The utility of checklists is well recognised, and there are paper-based checklists available to assist with some aspects of antenatal care. Where checklists do exist, there is often redundancy between assessments with individual risk factors appearing in more than one tool. Consequently, clinicians may have to complete several paper assessments, as well as a more general assessment relying on their own recognition of risk factors and recall of guideline recommendations. This is a point at which errors can be made.

There are also pitfalls in the interpretation of fetal growth scans – a key tool in the assessment of a baby’s wellbeing. The traditional paradigm involves the identification of the smallest babies, known as being ‘small-for-gestational age’. Some small babies have failed to achieve their growth potential and may be at greater risk of adverse outcomes, including stillbirth: this is known as ‘fetal growth restriction’. The focus on small babies alone is problematic because not all growth-restricted babies are small, and not all small babies are growth restricted. Growth-restricted babies that do not fall below the required size threshold may be missed, and yet they are at high risk of stillbirth – especially if not correctly identified. The definition and detection of growth restriction is more complex, may require complex calculations, and can easily be missed by those less experienced in scan interpretation. The failure to identify features of growth restriction can put babies at risk.

I propose ambitious yet simple solutions – a unified, computerised antenatal checklist incorporating existing risk assessments and recommendations in one place, and a digital tool to assist with the identification of growth restriction based on ultrasound scan features. I fervently believe that such tools have the potential reduce the risk of harm to mothers and babies, including the risk of stillbirth.