A pilot randomized controlled trial of two regimens of fetal surveillance for small-for-gestational-age fetuses with normal results of umbilical artery Doppler velocimetry

McCowan, Lesley; Harding, Jane E.; Ab, Roberts; Barker, Sarah E.; Ford, Cassandra; Stewart, Alistair

doi:10.1016/s0002-9378(00)70494-7

Cited by 99 publications

(61 citation statements)

References 21 publications

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“…The study population were participants in a series of antenatal 8,9 and postnatal studies. 10,11 These studies were approved by the Auckland ethics committee.…”

Section: Methodsmentioning

confidence: 99%

Customised birthweight centiles predict SGA pregnancies with perinatal morbidity

McCowan

Harding

Stewart

2005

BJOG

Self Cite

195

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Objectives To determine the following: (1) the proportion of babies reclassified as small or appropriately grown using customised and population centiles; and (2) the relative risks of perinatal morbidity, including abnormal umbilical Doppler studies, in babies classified as small for gestational age (SGA) and appropriate for gestational age (non‐SGA) using the two centile calculations. Design Cohort study in SGA and general hospital populations. Setting National Women's Hospital, Auckland, NZ. Population A cohort of SGA pregnancies (n= 374) and a general obstetric population (n= 12,879). Methods Pregnancy outcomes were compared between ‘non‐SGA both’ (≥10th% by population and customised centiles) and those who were ‘SGA both’ (<10th% by population and customised centiles), ‘SGA customised only’ (SGA by customised but non‐SGA by population centiles) and ‘SGA population only’ (SGA by population but non‐SGA by customised centiles). Main outcome measures Maternal and newborn morbidity and perinatal death. Results In the SGA cohort 271 (72%) babies were ‘SGA both’, 27 (7%) were ‘SGA customised only’, 32 (9%) were ‘population SGA only’ and 44 (12%) were ‘non‐SGA both’. In the general obstetric population 863 (6.7%) babies were ‘SGA both’, 445 (3.5%) were ‘customised SGA only’, 285 (2.2%) were ‘population SGA only’ and 11,286 (88%) were ‘non‐SGA both’. Perinatal death and newborn morbidity including nursery admission and long hospital stay were increased and comparable between ‘SGA both’ and ‘customised SGA only’ in both study populations. Newborn morbidity was low and comparable between ‘population SGA only’ and ‘non‐SGA both’. No perinatal deaths occurred in ‘population SGA only’ babies. Abnormal Doppler studies were more common in ‘SGA both’ or ‘customised SGA only’ but not in ‘population SGA only’ groups compared with ‘non‐SGA both’. Conclusions Customised birthweight centiles identified small babies at risk of morbidity and mortality. Use of customised centiles is likely to detect more babies at risk of perinatal morbidity and mortality than would be detected by population centiles.

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“…The study population were participants in a series of antenatal 8,9 and postnatal studies. 10,11 These studies were approved by the Auckland ethics committee.…”

Section: Methodsmentioning

confidence: 99%

Customised birthweight centiles predict SGA pregnancies with perinatal morbidity

McCowan

Harding

Stewart

2005

BJOG

Self Cite

195

View full text Add to dashboard Cite

show abstract

“…In this circumstance, continued biophysical testing (BPP weekly or modified BPP twice weekly) and delivery at 38-39 weeks is reasonable. This is supported in part by a pilot study conducted by McCowan and colleagues, 63 who randomized IUGR patients with normal umbilical artery Doppler velocimetry to twice weekly vs fortnightly fetal monitoring and found no differences in adverse outcomes between the groups. For the suspected constitutionally small IUGR fetus, it is also reasonable to continue weekly Doppler assessment but the caregiver should consider that only the middle cerebral artery Doppler findings may become abnormal if IUGR occurs.…”

Section: Summary Recommendationsmentioning

confidence: 79%

Timing Delivery of the Growth-Restricted Fetus

Galan

2011

Seminars in Perinatology

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“…Evidence supports those SGA fetuses with normal Doppler benefit from a non-intensive follow-up. 62 As a consequence of this evidence, SGA fetuses with normal Doppler have been claimed normal SGA fetuses, representing the lowest spectrum of healthy fetuses and to manage them accordingly. 63,64 Some recent studies would suggest that even those normal-SGA would have a suboptimal perinatal and neurodevelopmental outcome, 65,66 suggesting that a proportion of these SGA fetuses are, in reality, lateonset mild IUGR cases.…”

Section: Iugr Versus Normal-sgamentioning

confidence: 97%

“…Cerebroumbilical ratio: It has been claimed that the relationship between the umbilical and cerebral flow provides a more sensitive tool to discriminate between constitutional SGA and IUGR as it may be decreased even when UA and MCA are very close to normal. In fact, animal models have demonstrated that this ratio is better correlated with hypoxia than its individual components 62,67 (Fig. 8).…”

Section: Iugr Versus Normal-sgamentioning

confidence: 97%