388Investigating the utility of the customised fetal growth chart: a pragmatic randomised controlled trial

Abstract

ple, but little is known about Aboriginal multifetal pregnancies. Yet multifetal pregnancies and births are often more complicated and have poorer outcomes than singleton pregnancies. We describe the pregnancies, births and outcomes for Aboriginal twins born in Western Australia (WA) and New South Wales (NSW) with comparisons to Aboriginal singletons (WA and NSW) and non-Aboriginal births (NSW). Methods: Whole-population birth and hospital records were linked for births during 2000-2013 (WA) and 2002-2008 (NSW). Descriptive statistics are reported for demographics, maternal health, pregnancy complications, births and infant outcomes. Results: Pregnancy complications were more common among mothers of Aboriginal twins than Aboriginal singletons (e.g. 17% of mothers of WA twins had hypertension/pre-eclampsia/eclampsia vs 8% for singletons) but similar to mothers of NSW non-Aboriginal twins. Most Aboriginal twins were born in principal referral, wom-en's or large public hospitals. The hospitals were often far from the mother's home (e.g. 31% of mothers of WA Aboriginal twins gave birth at hospitals located >3 hours by road from their home). Outcomes were worse for Aboriginal liveborn twins than Aboriginal singletons and non-Aboriginal twins (e.g. 58% of NSW Aboriginal twins were preterm versus 9% of Aboriginal singletons and 49% non-Aboriginal twins). Conclusions: Mothers of Aboriginal twins faced significant challenges during the pregnancy, birth and the postnatal period in hospital. Key messages: In addition to accessible specialist medical care, these mothers may need extra practical and psychosocial support throughout their journey. Key messages: Good health among older Aboriginal people may also benefit the health of subsequent generations. Abstract #: 388 Investigating the utility of the customised fetal growth chart: a pragmatic randomised controlled trial Background: To determine if the routine use of a customised fetal growth chart, when compared to a standard growth chart, reduces the risk of adverse pregnancy outcome through increased detection of adverse growth. Methods: A double-blind, single centre, randomised controlled trial was conducted. All women with a singleton pregnancy receiving routine antenatal care through hospital clinics were included and randomised to either a standard growth chart (SC) or a customised growth chart (CC). Serial measurements of symphyseal fundal height (SFH) were plotted onto the chart in the electronic clinical record ; pre-programmed alerts notified the clinician when growth or size required review. The primary outcome measure was a composite perinatal morbidity/mortality outcome. Results: 3993 women were recruited; 45.4% nulliparous; 50.0% Caucasian, 17.8% Asian; 34.9% were overweight/obese prior to pregnancy; average 30 (SD 5.5) years old. The median (IQR) number of growth alerts was 2 (0-3) for both groups (p ¼ 0.378); there was no difference in the total number of ultrasounds per pregnancy (median [IQR] 3 [2-4] for both groups, p ¼ 0.266). There was no