First‐trimester and combined first‐ and second‐trimester prediction of small‐for‐gestational age and late fetal growth restriction

Sotiriadis, Alexandros; Figueras, F.; Eleftheriades, Makarios; Papaioannou, George; Chorozoglou, G.; Dinas, Konstantinos; Papantoniou, Nikolaos

doi:10.1002/uog.19055

Cited by 23 publications

(24 citation statements)

References 44 publications

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“…The validation results showed that our prediction model has high accuracy and stability. However, we found no associations among assisted conception, previous stillbirth, an adverse obstetrical history, the hemoglobin level and late-onset FGR, which was inconsistent with the findings of other studies (10,11,21). The results may differ because of the sample sizes and the population characteristics.…”

Section: Discussioncontrasting

confidence: 99%

“…Previous studies have assessed the performance of prenatal screening, with the combination of maternal characteristics, fetal biometry, Doppler parameters and biochemical markers, for the detection of FGR (10)(11)(12)(13)(14). Although they showed improved performance in the identification of early onset FGR, these models remained unsatisfactory for late-onset FGR.…”

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confidence: 99%

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Prediction of late-onset fetal growth restriction using a combined first- and second-trimester screening model in South Chinese infants: a retrospective study

Zheng

Feng

Zhang

et al. 2020

Preprint

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Background: Prediction models for early and late fetal growth restriction (FGR) have been established in many high-income countries. However, prediction models for late FGR in China are limited. This study aimed to develop a simple combined first- and second-trimester prediction model for screening late-onset FGR in South Chinese infants. Methods: This retrospective study included 2258 women who had singleton pregnancies and received routine ultrasound scans as training dataset. A validation dataset including 565 pregnant women was used to evaluate the model in order to enable an unbiased estimation. Late-onset FGR was defined as a birth weight < the 10th percentile plus abnormal Doppler indices and/or a birth weight below the 3rd percentile after 32 weeks, regardless of the Doppler status. Multivariate logistic regression was used to develop a prediction model. The model included the a priori risk (maternal characteristics), the second-trimester head circumference (HC/AC) / abdomen circumference (HC) ratio and estimated fetal weight (EFW). Results: Ninety-three fetuses were identified as late-onset FGR. The significant predictors for late-onset FGR were maternal age, height, weight, and medical history; the second-trimester HC/ AC ratio; and the EFW. This model achieved a detection rate (DR) of 52.6% for late-onset FGR at a 10% false positive rate (FPR) (area under the curve (AUC): 0.80, 95%CI 0.76-0.85). The AUC of the validation dataset was 0.65 (95%CI 0.54-0.78). Conclusions: A multivariate model combining first- and second-trimester default tests can detect 52.6% of cases of late-onset FGR at a 10% FPR. Further studies with more screening markers are needed to improve the detection rate.

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Section: Discussioncontrasting

confidence: 99%

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confidence: 99%

Prediction of late-onset fetal growth restriction using a combined first- and second-trimester screening model in South Chinese infants: a retrospective study

Zheng

Feng

Zhang

et al. 2020

Preprint

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“…Mean maternal age at evaluation was 32.2 (SD 1.3) years and mean maternal BMI was 23.4 (SD 1.7) kg/m 2 . Among studies evaluating suspected SGA (numbers are not mutually exclusive), 28% (460/1641) of cases had composite adverse perinatal outcome, 25.9% (555/2147) required admission to the neonatal unit, 17% (187/1102) had CS‐IFC, 1.7% (12/725) had 5‐min Apgar score < 7, 6.1% (78/1279) had neonatal acidosis and 2.7% (5/185) had perinatal death. Among studies evaluating SGA neonates (numbers are not mutually exclusive), 29.7% (265/891) of cases had composite adverse perinatal outcome, 18.6% (165/888) required admission to the neonatal unit, 12.5% (465/3727) had CS‐IFC, 1.8% (65/3540) had 5‐min Apgar score < 7, 3.5% (83/2372) had neonatal acidosis and 0.7% (26/3562) had perinatal death.…”

Section: Resultsmentioning

confidence: 99%

“…Information on the prediction of any composite of adverse perinatal outcome by abnormal uterine artery Doppler was available in eight studies; pooled sensitivity and specificity were 46% (95% CI, 37.4–54.9%) and 83.2% (95% CI, 75.4–88.9%), respectively. Among eight studies, pooled sensitivity and specificity for neonatal unit admission were 44.9% (95% CI, 34.2–56.1%) and 83.4% (95% CI, 76.4–88.6%), respectively. Among five studies, pooled sensitivity and specificity for CS‐IFC were 34.6% (95% CI, 23.7–47.4%) and 79.8% (95% CI, 74.3–84.4%), respectively.…”

Section: Resultsmentioning

confidence: 99%

Third‐trimester uterine artery Doppler for prediction of adverse outcome in late small‐for‐gestational‐age fetuses: systematic review and meta‐analysis

Martinez‐Portilla

Caradeux

Meler

et al. 2020

Ultrasound in Obstet & Gyne

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CONTRIBUTION What are the novel findings of this work?This study provides evidence of a higher risk of adverse outcome in suspected third-trimester small-forgestational-age (SGA) fetuses with abnormal uterine artery Doppler, which is comparable to that in late SGA fetuses with abnormal cerebroplacental ratio. What are the clinical implications of this work?The findings from this study should enable clinicians to assess the risk of adverse perinatal outcome in SGA fetuses, using the likelihood ratios of abnormal third-trimester uterine artery Doppler to calculate the posterior probability, using an evidence-based approach. ABSTRACTObjective To investigate the predictive ability for adverse perinatal outcome of abnormal third-trimester uterine artery Doppler in late small-for-gestational-age (SGA) fetuses.Methods A systematic search was performed to identify relevant observational studies and randomized controlled trials evaluating the performance of abnormal third-trimester uterine artery Doppler for the prediction of adverse perinatal outcome in suspected SGA fetuses and SGA neonates. Abnormal uterine artery Doppler was defined as uterine artery pulsatility index > 95 th percentile or ≥ 2 SD above the mean, or bilateral uterine artery notching. Hierarchical summary receiver-operating-characteristics (ROC) curves were con-structed using random-effects modeling. Bayesian analysis was used to calculate the posterior probability of adverse perinatal outcome following an abnormal or normal uterine artery Doppler assessment.Results Seventeen observational studies (including 7552 fetuses either diagnosed with suspected SGA (n = 3461) or later diagnosed as a SGA neonate (n = 4091)) met the inclusion criteria; no randomized-controlled trials met the inclusion criteria. Summary ROC curves showed that, among suspected SGA fetuses, the best predictive accuracy of abnormal third-trimester uterine artery Doppler was for perinatal mortality and the worst was for composite adverse perinatal outcome, with areas under the summary ROC curves of 0.90 and 0.66, respectively. The corresponding positive and negative likelihood ratios were 16.5 and 0.6 for perinatal mortality and 2.82 and 0.65 for composite adverse perinatal outcome, respectively. Following an abnormal vs normal uterine artery Doppler assessment, the posterior risks for composite adverse perinatal outcome, admission to the neonatal intensive care unit, Cesarean section for intrapartum fetal compromise, 5-min Apgar score < 7, neonatal acidosis and perinatal death were: 52.3% vs 20.2%, 48.6% vs 18.7%, 23.1% vs 15.2%, 3.59% vs 1.32%, 9.15% vs 5.12% and 31.4% vs 1.64%, respectively.Conclusion Abnormal uterine artery Doppler in the third trimester appears to be moderately useful in predicting perinatal death in pregnancies with suspected SGA.

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“…Similarly, Sotiriadis et al. reported that a simple model combining maternal and first-and second-trimester predictors can detect 60% of fetuses that will develop late FGR, and 79% of those fetuses that will be classified prenatally as late FGR 25 .…”

Section: Discussionmentioning

confidence: 99%

İkinci trimesterde seri fetal abdominal çapın ölçümü gebelik haftasına göre düşük doğum ağırlığını ve fetal gelişim geriliğini öngörebilir mi?

Şahin

Madendağ

2020

Cukurova Medical Journal

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ÖzPurpose: The aim of the present study was to evaluate whether serial measurements of the ultrasonographic abdominal circumference of the fetus in the second trimester is a predictor for a fetus that is small for gestational age and for late fetal-growth restrictions. Materials and Methods: Of the 440 pregnant women were analyzed retrospectively, 200 were in the small for gestational age group, 40 were in the late fetal-growth restrictions group, and 200 were in the healthy control group. For screening fetal growth, ultrasound scans were performed at 18±2, 22±2, and 26±2 weeks of gestation and fetal biometric results were compared among groups. Results: The maternal age, body mass index, nulliparity, and rates of previous cesarean deliveries were similar among the groups. Gestational age at delivery, rates of induced delivery and fetal birth weight were significantly different among the groups. The abdominal circumference diameter at 18, 22, and 26 weeks were similar among the groups; the differences were not significant. Conclusion: Our results suggest that the serial abdominal circumference measurement in the second trimester has a low capacity for predicting small for gestational age and late fetal-growth restrictions in low-risk pregnancies. Amaç: Bu çalışmanın amacı ikinci trimesterde seri olarak ölçülen ultrasonografik fetal abdominal çapın gebelik haftasına göre düşük doğum ağırlığı ve geç başlangıçlı fetal gelişim geriliğini öngörebilirliğini araştırmaktır. Gereç ve Yöntem: Toplam 440 gebe retrospektif olarak analiz edilmiş olup 200 gebe gebelik haftasına göre düşük doğum ağırlığı, 40 gebe geç başlangıçlı fetal gelişim geriliği ve 200 gebe sağlıklı kontrol grubu olarak sınıflandırıldı. Fetal büyümenin taranması ultrasonografi ile 18±2, 22±2, ve 26±2 gebelik haftalarında yapıldı ve fetal biyometrik ölçümler gruplar arasında karşılaştırıldı. Bulgular: Maternal yaş, vucut kitle indeksi, nulliparite ve önceki sezaryen doğum oranları gruplar arasında benzer olarak saptandı. Doğum sırasındaki gebelik haftası, doğum indüksiyonu oranları ve fetal doğum ağırlığı gruplar arasında anlamlı farklılık gösterdi. 18, 22 ve 26. haftalardaki fetal abdominal çap gruplar arasında benzerdi; anlamlı farklılık saptanmadı. Sonuç: Sonuçlarımız, ikinci trimesterdeki seri fetal abdominal çapın ölçümünün düşük riskli gebeliklerde gebelik haftasına göre düşük doğum ağırlığı ve geç başlangıçlı fetal gelişim geriliğini öngörmede düşük bir kapasiteye sahip olduğunu göstermektedir.

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First‐trimester and combined first‐ and second‐trimester prediction of small‐for‐gestational age and late fetal growth restriction

Abstract: A simple model combining maternal and first- and second-trimester predictors can detect 60% of fetuses that will develop late FGR, and 79% of those fetuses that will be classified prenatally as late FGR, for a 10% FPR. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Cited by 23 publications

References 44 publications

Prediction of late-onset fetal growth restriction using a combined first- and second-trimester screening model in South Chinese infants: a retrospective study

Prediction of late-onset fetal growth restriction using a combined first- and second-trimester screening model in South Chinese infants: a retrospective study

Third‐trimester uterine artery Doppler for prediction of adverse outcome in late small‐for‐gestational‐age fetuses: systematic review and meta‐analysis

İkinci trimesterde seri fetal abdominal çapın ölçümü gebelik haftasına göre düşük doğum ağırlığını ve fetal gelişim geriliğini öngörebilir mi?

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