Does detection of fetal growth restriction improve neonatal outcomes?

Selvaratnam, Roshan J; Wallace, Euan; Treleaven, Sophie; Hooper, Stuart B.; Davis, Peter G; Davey, Mary‐Ann

doi:10.1111/jpc.15310

Cited by 11 publications

(13 citation statements)

References 26 publications

(54 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In Victoria they represented 53% of all infants delivered early for suspected FGR 2 and had higher rates of preterm birth and neonatal morbidity due to inadvertent early delivery. 8,24 However, despite their earlier mean gestation at birth, the longer-term developmental and educational outcomes for these with normal growth who were delivered early for suspected FGR were no different than those for similar infants not suspected of having FGR. The challenge, though, is to develop clinical markers of pathology, rather than simply size, that better predict the fetus that is at risk of adverse outcome and in need of earlier delivery.…”

Section: Discussionmentioning

confidence: 94%

Association Between Iatrogenic Delivery for Suspected Fetal Growth Restriction and Childhood School Outcomes

Selvaratnam

Wallace

Wolfe

et al. 2021

JAMA

View full text Add to dashboard Cite

delivery worldwide, and the significant morbidity and mortality that can occur with abnormal implantation or placentation following a cesarean delivery, attention to optimizing operative techniques to minimize these risks would seem to be important. Although limited data are available, in 1 previous study, a cesarean delivery performed after labor was associated with a lower risk of accreta in the next pregnancy (Am J Perinatol 2020;37:633-637), and there are likely characteristics of the uterine closure and scar that contribute to risk.It has been hypothesized that different closure techniques might be associated with difference in risk of CSP and abnormal placentation, but the jury is still out (J Obstet Gynaecol 2021;1-8). It does seem that further data would be helpful in guiding management of the first cesarean to decrease the risk in subsequent pregnancies. This would seem like an important area of investigation that could make a substantial difference in the morbidity and mortality of these subsequent pregnancies.-MEN)

show abstract

Section: Discussionmentioning

confidence: 94%

Association Between Iatrogenic Delivery for Suspected Fetal Growth Restriction and Childhood School Outcomes

Selvaratnam

Wallace

Wolfe

et al. 2021

JAMA

View full text Add to dashboard Cite

show abstract

“…In the updated American College of Obstetricians and Gynecologist (ACOG) Practice Bulletin, fetal growth restriction (FGR) is defined based on a sonographic estimated fetal weight (EFW) less than 10th percentile for gestational age while small for gestational age (SGA) is defined based on a birth weight less than 10th percentile for gestational age [ 1 ]. FGR or SGA increases the risks of perinatal morbidity and mortality [ 2 – 4 ]. Furthermore, these categories of children are also at risks of long-term complications such as neurodevelopmental delay, adult obesity and metabolic diseases [ 5 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

Should singleton birth weight standards be applied to identify small-for-gestational age twins?: analysis of a retrospective cohort study

Lin

Rao

Fan

et al. 2021

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

Background Twin birth weight percentiles are less popular in clinical management among twin pregnancies compared with singleton ones in China. This study aimed to compare the incidence and neonatal outcomes of small for gestational age (SGA) twins between the use of singleton and twin birth weight percentiles. Methods This was a retrospective cohort study of 3,027 pregnancies with liveborn twin pairs at gestational age of > 28 weeks. The newborns were categorized as SGA when a birthweight was less than the 10th percentile based on the singleton and twin references derived from Chinese population. Logistic regression models with generalized estimated equation (GEE) were utilized to evaluate the association between SGA twins and neonatal outcomes including neonatal unit admission, neonatal jaundice, neonatal respiratory distress (NRDS), neonatal asphyxia, ventilator support, hypoxic ischemic encephalopathy (HIE), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), intracranial hemorrhage (ICH), culture-proven sepsis, neonatal death within 28 days after birth as well as the composite outcome. Results The incidence of SGA was 33.1 % based on the singleton reference and 7.3 % based on the twin reference. Both of SGA newborns defined by the singleton and twin references were associated with increases in neonatal unit admission, neonatal jaundice and ventilator support. In addition, SGA newborns defined by the twin reference were associated with increased rates of BPD (aOR, 2.61; 95 % CI: 1.18–5.78) as well as the severe composite outcome (aOR, 1.93; 95 % CI: 1.07–3.47). Conclusions The use of singleton birth weight percentiles may result in misdiagnosed SGA newborns in twin gestations and the twin birth weight percentiles would be more useful to identify those who are at risk of adverse outcomes.

show abstract

“…In Victoria, improved detection of FGR was accompanied by a five‐fold increase in early delivery for normally grown babies and an increase in neonatal morbidity among those babies 3 . Our concern is that, unchecked, driving increased detection of FGR, albeit reducing stillbirth, will increase potentially harmful interventions for healthy pregnancies 21 . The challenge for clinicians and hospitals is that while they are provided directed feedback of their performance in the detection of severe FGR, the unintended harm is not yet reported or visible.…”

Section: Discussionmentioning

confidence: 99%

Preventing harm: A balance measure for improving the detection of fetal growth restriction

Selvaratnam

Wallace

Hunt

et al. 2021

Aust NZ J Obst Gynaeco

Self Cite

View full text Add to dashboard Cite

Background Increasing the detection of fetal growth restriction (FGR), while reducing stillbirth, also leads to unnecessary early intervention, and associated morbidity, for normally grown babies who are incorrectly suspected of FGR. Aims We sought to design a balance measure that addresses the specificity of FGR detection. Methods A retrospective cohort study on all singleton births ≥32 weeks gestation in 2016 and 2017 in Victoria. We compared two balance measures for the detection of FGR, defined as the proportion of all babies iatrogenically delivered before 39 weeks gestation for suspected FGR that had a birthweight ≥10th centile (balance measure 1) or ≥25th centile (balance measure 2). Hospital level performance on each balance measure was derived and compared to an existing performance measure for severe FGR detection in Victoria. Results Of the 38 hospitals analysed, 12 (32%) had a favourable performance on an existing indicator of FGR detection, seven (18%) hospitals had a favourable performance on balance measure 1, and 15 (39%) had a favourable performance on balance measure 2. There was a moderate correlation between hospital performance on the existing indicator and on balance measure 1 (r = 0.447, P = 0.005) but not balance measure 2 (r = −0.063, P = 0.71). There was no difference in perinatal mortality between high performing hospitals and low performing hospitals. Conclusion Introducing a balance measure into routine reporting may bring greater awareness to the unintended harm associated with increased detection of FGR.

show abstract

Does detection of fetal growth restriction improve neonatal outcomes?

Cited by 11 publications

References 26 publications

Association Between Iatrogenic Delivery for Suspected Fetal Growth Restriction and Childhood School Outcomes

Association Between Iatrogenic Delivery for Suspected Fetal Growth Restriction and Childhood School Outcomes

Should singleton birth weight standards be applied to identify small-for-gestational age twins?: analysis of a retrospective cohort study

Preventing harm: A balance measure for improving the detection of fetal growth restriction

Contact Info

Product

Resources

About