Biochemical tests of placental function versus ultrasound assessment of fetal size for stillbirth and small-for-gestational-age infants

Heazell, Alexander; Hayes, Dexter J. L.; Whitworth, Melissa; Takwoingi, Yemisi; Bayliss, Sue; Davenport, Clare

doi:10.1002/14651858.cd012245.pub2

Cited by 51 publications

(57 citation statements)

References 371 publications

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“…However, it is not strongly predictive of the risk of associated complications, such as shoulder dystocia. Similar observations have been made in relation to ultrasonically suspected SGA [60,61]. That study indicated that reduced fetal abdominal growth velocity helped discriminate between healthy SGA babies and those that were at increased risk of complications.…”

Section: Plos Medicinesupporting

confidence: 75%

Universal third-trimester ultrasonic screening using fetal macrosomia in the prediction of adverse perinatal outcome: A systematic review and meta-analysis of diagnostic test accuracy

et al. 2020

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Background The effectiveness of screening for macrosomia is not well established. One of the critical elements of an effective screening program is the diagnostic accuracy of a test at predicting the condition. The objective of this study is to investigate the diagnostic effectiveness of universal ultrasonic fetal biometry in predicting the delivery of a macrosomic infant, shoulder dystocia, and associated neonatal morbidity in low-and mixed-risk populations. Methods and findings We conducted a predefined literature search in Medline, Excerpta Medica database (EMBASE), the Cochrane library and ClinicalTrials.gov from inception to May 2020. No language restrictions were applied. We included studies where the ultrasound was performed as part of universal screening and those that included low-and mixed-risk pregnancies and excluded studies confined to high risk pregnancies. We used the estimated fetal weight (EFW) (multiple formulas and thresholds) and the abdominal circumference (AC) to define suspected large for gestational age (LGA). Adverse perinatal outcomes included macrosomia (multiple thresholds), shoulder dystocia, and other markers of neonatal morbidity. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Meta-analysis was carried out using the hierarchical summary receiver

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Section: Plos Medicinesupporting

confidence: 75%

Universal third-trimester ultrasonic screening using fetal macrosomia in the prediction of adverse perinatal outcome: A systematic review and meta-analysis of diagnostic test accuracy

et al. 2020

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“…Interestingly, of the SGA babies in ReMIT-2, a slightly greater proportion were delivered prior to 39 weeks' gestation in the intervention arm than in the control arm suggesting that identification of SGA babies in the intervention arm was more likely, which then prompted delivery. This observation would be consistent with the findings of the review of diagnostic test accuracy studies [17]. Nevertheless, the use of a composite outcome is a limitation of the current trial and our findings reinforce the need to ensure appropriate outcome measures are used in a main trial to enable robust conclusions to be drawn.…”

Section: Discussionsupporting

confidence: 90%

“…A recent systematic review of diagnostic test accuracy studies evaluated the ability of placental biomarkers to detect pregnancies ending in the birth of a small for gestational age (SGA) infant or a stillbirth compared with those identified via the ultrasound assessment of estimated fetal weight (EFW). This review determined that placental growth factor (PlGF) gave the highest diagnostic odds ratio (49.2; 95% confidence interval [CI] 12.7 to 191) for detecting pregnancies ending in stillbirth and performed well in the prediction of SGA neonates [17]. As the data were based on 5894 pregnancies of which only 16 ended in stillbirth and no studies investigated EFW in the prediction of stillbirth, the review concluded that further research was required to determine the diagnostic accuracy of placental biomarkers alone and in combination with EFW in the identification of adverse pregnancy outcomes [17].…”

Section: Introductionmentioning

confidence: 99%

“…This review determined that placental growth factor (PlGF) gave the highest diagnostic odds ratio (49.2; 95% confidence interval [CI] 12.7 to 191) for detecting pregnancies ending in stillbirth and performed well in the prediction of SGA neonates [17]. As the data were based on 5894 pregnancies of which only 16 ended in stillbirth and no studies investigated EFW in the prediction of stillbirth, the review concluded that further research was required to determine the diagnostic accuracy of placental biomarkers alone and in combination with EFW in the identification of adverse pregnancy outcomes [17]. In addition, a cohort study of 300 women with RFM after 28 weeks' gestation found that the addition of PlGF measurement improved the sensitivity for the detection of a composite adverse pregnancy outcome to 36% from 19% [18].…”

Section: Introductionmentioning

confidence: 99%

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Standard care informed by the result of a placental growth factor blood test versus standard care alone in women with reduced fetal movement at or after 36+0 weeks’ gestation: a pilot randomised controlled trial

Armstrong-Buisseret

Godolphin

Bradshaw

et al. 2020

Pilot Feasibility Stud

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Background: Biomarkers of placental function can potentially aid the diagnosis and prediction of pregnancy complications. This randomised controlled pilot trial assessed whether for women with reduced fetal movement (RFM), intervention directed by the measurement of a placental biomarker in addition to standard care was feasible and improved pregnancy outcome compared with standard care alone. Methods: Women aged 16-50 years presenting at eight UK maternity units with RFM between 36 +0 and 41 +0 weeks' gestation with a viable singleton pregnancy and no indication for immediate delivery were eligible. Participants were randomised 1:1 in an unblinded manner to standard care and a biomarker blood test result revealed and acted on (intervention arm) or standard care where the biomarker result was not available (control arm). The objectives were to determine the feasibility of a main trial by recruiting 175-225 participants over 9 months and to provide proof of concept that informing care by measurement of placental biomarkers may improve outcome. Feasibility was assessed via the number of potentially eligible women, number recruited, reasons for non-recruitment and compliance. Proof of concept outcomes included the rates of the induction of labour and caesarean birth, and a composite adverse pregnancy outcome. Results: Overall, 2917 women presented with RFM ≥ 36 weeks, 352 were approached to participate and 216 (61%) were randomised (intervention n = 109, control n = 107). The main reason for not approaching women was resource/ staff issues (n = 1510). Ninety-seven women declined the trial, mainly due to not liking blood tests (n = 24) or not wanting to be in a trial (n = 21). Compliance with the trial interventions was 100% in both arms. Labour was induced in 97 (45%) participants (intervention n = 49, control n = 48), while 17 (9%) had planned caesarean sections (intervention n = 9, control n = 8). Overall, 9 (8%) babies in the intervention arm had the composite adverse pregnancy outcome versus 4 (4%) in the control arm.

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“…However, more recently the focus has shifted to non-invasive testing, such as ultrasound imaging of foetal structures and umbilical blood flow, and non-invasive prenatal screening (NIPS), designed to detect chromosome abnormalities [1]. Despite this recent focus, limited attention has pivoted to the detection of placental health as a surrogate for the well-being of pregnancy and thereby maternal and foetal health [2]. We and other investigators have recently developed novel imaging technology related to free-breathing magnetic resonance imaging including arterial spin labelling methodology that revealed detectable differences in-vivo during the early second trimester heralding subsequent development of ischaemic placental disease [3].…”

Section: Introductionmentioning

confidence: 99%

Cell-free DNA Methylation and Transcriptomic Signature Prediction of Pregnancies with Adverse Outcomes

Vecchio

et al. 2020

Epigenetics

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Although analysis of maternal plasma cell-free content has been employed for screening of genetic abnormalities within a pregnancy, limited attention has been paid to its use for the detection of adverse pregnancy outcomes (APOs) based on placental function. Here we investigated cell-free DNA and RNA content of 102 maternal and 25 cord plasma samples. Employing a novel deconvolution methodology, we found that during the first trimester, placenta-specific DNA increased prior to the subsequent development of gestational diabetes with no change in patients with preeclampsia while decreasing with maternal obesity. Moreover, using cell-free RNA sequencing, APOs revealed 71 differentially expressed genes early in pregnancy. We noticed the upregulation of S100A8, MS4A3, and MMP8 that have been already associated with APOs but also the upregulation of BCL2L15 and the downregulation of ALPL that have never been associated with APOs. We constructed a classifier with a positive predictive ability (AUC) of 0.91 for APOs, 0.86 for preeclampsia alone and 0.64 for GDM. We conclude that placenta-specific cell-free nucleic acids during early gestation provide the possibility of predicting APOs prior to the emergence of characteristic clinical features.

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Biochemical tests of placental function versus ultrasound assessment of fetal size for stillbirth and small-for-gestational-age infants

Abstract: Biochemical tests of placental function versus ultrasound assessment of fetal size for stillbirth and small-for-gestational-age infants.

Cited by 51 publications

References 371 publications

Universal third-trimester ultrasonic screening using fetal macrosomia in the prediction of adverse perinatal outcome: A systematic review and meta-analysis of diagnostic test accuracy

Universal third-trimester ultrasonic screening using fetal macrosomia in the prediction of adverse perinatal outcome: A systematic review and meta-analysis of diagnostic test accuracy

Standard care informed by the result of a placental growth factor blood test versus standard care alone in women with reduced fetal movement at or after 36+0 weeks’ gestation: a pilot randomised controlled trial

Cell-free DNA Methylation and Transcriptomic Signature Prediction of Pregnancies with Adverse Outcomes

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