Growth Assessment Protocol (GAP)

The Perinatal Institute has put together a comprehensive programme which is offered to units already using the GROW software
and new units who now want to implement GROW. The following links give details of the programme: GAP SLA   
The following details the Perinatal Institute Terms of Service: Terms of service

GAP E-Learning

To access the E-Learning portal or reset your E-Learning password please use the following links:   GAP-Elearning     Reset Password

GAP Guidance

The new GAP Care Pathway aligned with NHS Saving Babies Lives' Care Bundle version 2 is available here: GAP Guidance

Recent Publications

  • Customized growth charts: rationale, validation and clinical benefits              
  • Fetal growth surveillance – Current guidelines, practices and challenges        
  • Customised vs INTERGROWTH-21st standards                                                      

GAP is based on the following key elements:

  1. Evidence based protocols and risk assessment algorithms
  2. Training and accreditation of all staff involved in clinical care
  3. Implementation of customised GROW chart and audit tool
  4. Rolling audit and benchmarking of performance

 

Further information - see MIDIRS article:                 

Resources

GAP training - dates of forthcoming workshops are listed here.

GAP uptake - click here for a list of UK Trusts and Health Boards

Fundal Height Measurement - click here for video demonstration.

Lecture - click here to view a presentation by Prof Jason Gardosi on Preventing Stillbirth: A National Campaign on 1/7/2016 (24 minutes)

Rationale

• Most 'unexplained' stillbirths were growth restricted    • Customised charts and appropriate protocols should be used   
• Most stillbirths with IUGR are avoidable    • Standardised FH measurement and referral improves detection      
• A/N detection improves outcome and reduces SB    • In high risk pregnancy, serial scans improve detection   

Effect on Stillbirth

A co-ordinated growth assessment programme has reduced ONS stillbirth rates in three English regions with high uptake (West Midlands, Yorkshire & The Humber, North East). For detailed analysis, see BMJ Open 2013 and J Public Health 2014

The reduction is mainly in stillbirths with IUGR                            The Times Leading Article 

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To date, 78% of Trusts and Health Boards in the UK have implemented GAP. The increasing national uptake is mirrored by ONS stillbirth rates in England, which have seen a year-on-year reduction to their lowest ever levels.

The 2018 stillbirth rate in England, released by ONS in July 2019, has fallen again - to 4.01. This represents a 25% reduction from the 2000-09 (10 year) baseline.