Modalités de dépistage et de diagnostic du fœtus petit pour l’âge gestationnel

Grangé, G.

doi:10.1016/j.jgyn.2013.09.015

Cited by 14 publications

(1 citation statement)

References 28 publications

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“…This is particularly important in African countries where the proportion of SGA newborns is estimated to be as high as 25% and the human and financial resources for the management of these children are limited. Finally, given the limited accuracy of fetal growth standards for identifying fetuses at risk of adverse perinatal outcomes [36], other strategies combining fetal biometry with biomarkers for FGR and women's clinical characteristics may find their place in the future [37]. Feasibility and cost-effectiveness will be important determinants of the large-scale use of this type of diagnostic tool in Africa.…”

Section: Plos Onementioning

confidence: 99%

Assessing fetal growth in Africa: Application of the international WHO and INTERGROWTH-21st standards in a Beninese pregnancy cohort

Yovo¹,

Agbota

Hocquette

et al. 2022

PLoS ONE

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Background Fetal growth restriction is a major complication of pregnancy and is associated with stillbirth, infant death and child morbidity. Ultrasound monitoring of pregnancy is becoming more common in Africa for fetal growth monitoring in clinical care and research, but many countries have no national growth charts. We evaluated the new international fetal growth standards from INTERGROWTH-21st and WHO in a cohort from southern Benin. Methods Repeated ultrasound and clinical data were collected in women from the preconceptional RECIPAL cohort (241 women with singleton pregnancies, 964 ultrasounds). We modelled fetal biometric parameters including abdominal circumference (AC) and estimated fetal weight (EFW) and compared centiles to INTERGROWTH-21st and WHO standards, using the Bland and Altman method to assess agreement. For EFW, we used INTERGROWTH-21st standards based on their EFW formula (IG21st) as well as a recent update using Hadlock’s EFW formula (IG21hl). Proportions of fetuses with measurements under the 10th percentile were compared. Results Maternal malaria and anaemia prevalence was 43% and 69% respectively and 11% of women were primigravid. Overall, the centiles in the RECIPAL cohort were higher than that of INTERGROWTH-21st and closer to that of WHO. Consequently, the proportion of fetuses under 10th percentile thresholds was systematically lower when applying IG21st compared to WHO standards. At 27–31 weeks and 33–38 weeks, respectively, 7.4% and 5.6% of fetuses had EFW <10th percentile using IG21hl standards versus 10.7% and 11.6% using WHO standards. Conclusion Despite high anemia and malaria prevalence in the cohort, IG21st and WHO standards did not identify higher than expected proportions of fetuses under the 10th percentiles of ultrasound parameters or EFW. The proportions of fetuses under the 10th percentile threshold for IG21st charts were particularly low, raising questions about its use to identify growth-restricted fetuses in Africa.

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Section: Plos Onementioning

confidence: 99%

Assessing fetal growth in Africa: Application of the international WHO and INTERGROWTH-21st standards in a Beninese pregnancy cohort

Yovo¹,

Agbota

Hocquette

et al. 2022

PLoS ONE

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Antenatal detection of fetal growth restriction and risk of stillbirth: population‐based case–control study

Ego

Monier

Skaare

et al. 2020

Ultrasound in Obstet & Gyne

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CONTRIBUTIONWhat are the novel findings of this work? This population-based study reports a smaller protective effect against stillbirth of detection of fetal growth restriction (FGR) than previous studies, with over 40% of stillbirths among small-for-gestational-age (SGA) fetuses occurring despite detection of FGR. What are the clinical implications of this work?In the context of universal ultrasound screening, these findings raise the possibility that routine examination may be less efficacious than is sonography indicated based on risk-factor criteria. They call into question focusing solely on improving detection of FGR without addressing management post-detection. Preventive strategies targeting all stillbirths may ultimately have a larger impact on the risks of SGA-related as well as other stillbirths. ABSTRACTObjectives Antenatal surveillance of intrauterine growth aims to detect growth-restricted fetuses (FGR), which face increased risk of stillbirth. Improving their detection could be an effective strategy for prevention of stillbirth. The French REPERE study was conducted to estimate the association between antenatal detection of FGR and risk of stillbirth.Methods REPERE is a case-control study performed in three French districts with a combined total of approximately 30 000 births annually. Cases were singleton small-for-gestational-age (SGA) stillbirths ≥ 24 weeks' gestation and without severe congenital anomaly, between 2012 and 2014, identified using a population-based stillbirth registry; controls were live births fulfilling the same Results During the study period, there were 92 182 births ≥ 22 weeks' gestation, including 669 stillbirths, of which 79 were singleton SGA stillbirths ≥ 24 weeks and without severe congenital anomaly. Of these cases, 44.3% (35/79) had FGR detected, compared with a detection rate of 36.2% in controls (154/426). The crude OR expressing the association between detection of FGR and risk of stillbirth was 1.4 (95% CI, 0.9-2.3) and the OR adjusted for parity, presence of risk factors for FGR, presence of vascular disorder and birth-weight percentile was 0.6 (95% CI, 0.3-1.0). Among deliveries ≥ 28 weeks, detection rates were 38.3% vs 36.0% for cases and controls, with an adjusted OR of 0.5 (95% CI, 0.2-1.0).Conclusion Antenatal detection of FGR was protective against stillbirth, but over 40% of stillbirths among SGA

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