Objective To investigate perinatal mortality, morbidity and obstetric intervention after introducing universal third-trimester ultrasound scan for growth restriction. Design Prospective cohort study Setting Oxfordshire (OUH), UK Population Women with a non-anomalous singleton pregnancy undergoing pregnancy care and term delivery at OUH with an estimated-date-of-birth between 01/Jan/2014 and 30/Sept/2019. Methods Universal ultrasound for fetal growth restriction between 35+0 and 36+6 weeks was introduced in 2016. The outcomes of the next 18631 eligible term pregnancies were compared, using logistic regression, with the previous 18636 who had clinically-indicated ultrasounds only. ‘Screen positives’ for growth restriction were managed according to a pre-determined protocol. Main Outcome Measures Extended perinatal mortality, a composite of mortality or encephalopathy Grade II-III, and expedited birth. Other outcomes included composite adverse outcomes used elsewhere, detection of birthweight (<10th centile) and birth <39+0 weeks. Results Extended perinatal deaths decreased from 1.7/1000 to 1.2/1000 births (aOR: 0.73; 0.43 -1.25); mortality or severe morbidity decreased from 2.9/1000 to 1.9/1000 births (OR: 0.67; 0.44-1.03). Expedited births increased from 35.2% to 37.7% (OR: 1.08; 1.04 – 1.14). Birth prior to 39+0 weeks fell 10.5% (OR 0.89: 0.85 – 0.94). Birthweight (<10th centile) detection using fetal biometry alone was 31.4%, and rose to 40.5% if all abnormal scan parameters were used. Conclusion Introducing a universal ultrasound for growth restriction has limited impact on mortality and severe morbidity, but only small increases in intervention, and less early-term birth, are possible. The detection of birthweight (<10th c) improved where markers of growth restriction are used.

OBJECTIVE Assess whether antenatal corticosteroids for fetal lung maturation are associated with hypoglycaemia in neonates born at term. DESIGN Cohort study of term singleton deliveries over a 3-year period. SETTING Tertiary UK hospital. POPULATION The cohort includes neonates not exposed to corticosteroids; those exposed before 34 weeks because of suspected preterm birth but delivered at term (group 1); those exposed after 34 weeks because of anticipated late preterm birth (group 2); and - included in the latter - a subgroup of neonates exposed within 7 days of their actual delivery (group 2a). METHODS Retrospective analysis of the association between exposure and neonatal outcomes using multivariate regression to adjust for confounders. MAIN OUTCOME MEASURES Severe neonatal hypoglycaemia requiring admission to NNU; and need for ventilatory support. RESULTS Amongst 20102 eligible pregnancies, 143 women received corticosteroids before 34 weeks; and 187 after 34 weeks, of which 106 were within 7 days of delivery. Severe hypoglycaemia occurred in 227 neonates. Univariate predictors of hypoglycaemia were maternal BMI, nulliparity, hypertension, diabetes, gestation at birth, birthweight<10 centile and corticosteroid exposure. Following adjustment for covariates, corticosteroid exposure was independently associated with hypoglycaemia in all exposed groups: group 1 adjusted odds ratio (aOR) 3.26 (1.38-7.73); group 2 aOR 4.56 (2.47-8.42); and group 2a aOR 5.70 (2.49-13.03). Ventilatory support was not significantly different in any of the exposed groups. CONCLUSION There is increased risk of hypoglycaemia in neonates exposed to antenatal corticosteroids who are born at term. The risk of hypoglycaemia is higher with decreasing corticosteroid-to-birth interval.