Second‐ to third‐trimester longitudinal growth assessment for prediction of small‐for‐gestational age and late fetal growth restriction

Objective To assess the additive value of fetal growth velocity between 32 and 36 weeks' gestation to the performance of ultrasonographic estimated fetal weight (EFW) at 35 + 0 to 36 + 6 weeks' gestation for prediction of delivery of a small‐for‐gestational‐age (SGA) neonate and adverse perinatal outcome. Methods This was a prospective study of 14 497 singleton pregnancies undergoing routine ultrasound examination at 30 + 0 to 34 + 6 and at 35 + 0 to 36 + 6 weeks' gestation. Multivariable logistic regression analysis was used to determine whether addition of growth velocity, defined as the difference in EFW Z‐score or abdominal circumference (AC) Z‐score between the early and late third‐trimester scans divided by the time interval between the scans, improved the performance of EFW Z‐score at 35 + 0 to 36 + 6 weeks in the prediction of, first, delivery of a SGA neonate with birth weight < 10th and < 3rd percentiles within 2 weeks and at any stage after assessment and, second, a composite of adverse perinatal outcome, defined as stillbirth, neonatal death or admission to the neonatal unit for ≥ 48 h. Results Multivariable logistic regression analysis demonstrated that significant contributors to the prediction of a SGA neonate were EFW Z‐score at 35 + 0 to 36 + 6 weeks' gestation, fetal growth velocity, by either AC Z‐score or EFW Z‐score, and maternal risk factors. The area under the receiver–operating characteristics curve (AUC) and detection rate (DR), at a 10% screen‐positive rate, for prediction of a SGA neonate < 10th percentile born within 2 weeks after assessment achieved by EFW Z‐score at 35 + 0 to 36 + 6 weeks (AUC, 0.938 (95% CI, 0.928–0.947); DR, 80.7% (95% CI, 77.6–83.9%)) were not significantly improved by addition of EFW growth velocity and maternal risk factors (AUC, 0.941 (95% CI, 0.932–0.950); P = 0.061; DR, 82.5% (95% CI, 79.4–85.3%)). Similar results were obtained when growth velocity was defined by AC rather than EFW. Similarly, there was no significant improvement in the AUC and DR, at a 10% screen‐positive rate, for prediction of a SGA neonate < 10th percentile born at any stage after assessment or a SGA neonate < 3rd percentile born within 2 weeks or at any stage after assessment, achieved by EFW Z‐score at 35 + 0 to 36 + 6 weeks by addition of maternal factors and either EFW growth velocity or AC growth velocity. Multivariable logistic regression analysis demonstrated that the only significant contributor to adverse perinatal outcome was maternal risk factors. Multivariable logistic regression analysis in the group with EFW < 10th percentile demonstrated that significant contribution to prediction of delivery of a neonate with birth weight < 10th and < 3rd percentiles and adverse perinatal outcome was provided by EFW Z‐score at 35 + 0 to 36 + 6 weeks, but not by AC growth velocity < 1st decile. Conclusion The predictive performance of EFW at 35 + 0 to 36 + 6 weeks' gestation for delivery of a SGA neonate and adverse perinatal outcome is not improved by addition of estimated growth ...

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prediction of small‐for‐gestational‐age neonates at 35–37 weeks' gestation: contribution of maternal factors and growth velocity between 32 and 36 weeks

Ciobanu

Anthoulakis

Syngelaki

et al. 2019

“…Despite advances in antenatal care, the search for a test to identify the fetus at risk for intrauterine demise continues. The cerebroplacental ratio (CPR), a marker of brain sparing, is emerging as a predictor of adverse perinatal outcome, fetal growth restriction (FGR), neonatal care unit admission, intrapartum fetal compromise, episodes of recurrent reduced fetal movements, postnatal circulatory problems and perinatal death in near-term fetuses [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] . Low CPR reflects redistribution of the cardiac output to the brain and has been shown to improve the accuracy of predicting adverse outcome, as compared with middle cerebral artery (MCA) or umbilical artery (UA) Doppler alone [19][20][21][22][23] .…”

Section: Introductionmentioning

confidence: 99%

Longitudinal change in cerebroplacental ratio in small‐for‐gestational‐age fetuses and risk of stillbirth

Kalafat

Öztürk

Sivanathan

et al. 2019

Objective To investigate whether assessment of longitudinal change in Doppler variables in small‐for‐gestational‐age (SGA) fetuses improves the prediction of those at risk of stillbirth. Methods This was a longitudinal study of two cohorts of singleton pregnancies, which included SGA and appropriate‐for‐gestational‐age (AGA) fetuses, respectively. The inclusion criteria for the SGA cohort were singleton pregnancy at ≥ 20 weeks' gestation, classified as SGA (estimated fetal weight < 10th centile). The AGA cohort consisted of singleton pregnancies deemed at high risk of being SGA, which were followed up longitudinally but remained AGA. Fetal middle cerebral artery (MCA) pulsatility index (PI) and umbilical artery (UA)‐PI were measured longitudinally and cerebroplacental ratio (CPR) was calculated, and values were converted to multiples of the median. The last two measurements prior to delivery were included in the analysis. Longitudinal models for Doppler variables were developed using linear‐mixed models and their accuracy in the prediction of stillbirth was tested using generalized linear models. A Bayesian framework was employed to compare the accuracy of longitudinal and standard (last‐scan measurement) models. Results In total, 1549 AGA and 941 SGA pregnancies were included in the analysis. There were 30 (3.2%) and no stillbirth cases in the SGA and AGA groups, respectively. Change in MCA‐PI, UA‐PI and CPR with advancing gestation was significantly different between liveborn AGA and SGA fetuses, with a less pronounced difference with advancing gestation. Using the last measurement, the best models for the prediction of stillbirth in SGA pregnancies were those based on CPR (accuracy, 75.0%; 95% CI, 72.6–77.2%) and UA‐PI (accuracy, 71.0%; 95% CI, 68.6–73.4%). The posterior probability of the standard CPR model having a higher accuracy compared with the UA‐PI model was 97.2% (magnitude of change (MC), 3.9%; 95% credible interval (CrI), 0.5–7.3%). The accuracies of the standard, compared with the longitudinal, models for UA‐PI (71.0% vs 72.8%), MCA‐PI (64.6% vs 63.8%) and CPR (75.0% vs 74.9%) in the prediction of stillbirth were not significantly different. The posterior probabilities for improvement in accuracy using longitudinal, compared with standard, assessment were 50.1% (MC, < 0.1%; 95% CrI, −3.3 to 3.3%), 35.2% (MC, −0.1%; 95% CrI, −4.5 to 2.8%) and 82.2% (MC, 1.9%; 95% CrI, −1.5 to 5.3%) for CPR, MCA‐PI and UA‐PI models, respectively. Therefore, change in Doppler parameters did not improve the accuracy of the prediction of stillbirth, compared with that of the last‐scan measurement. Conclusion Longitudinal assessment of Doppler parameters was not useful in improving the detection of stillbirth in SGA pregnancies, as compared with a single‐point assessment. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

“…However, late FGR is difficult to diagnose 3 . So far, there are only limited data regarding screening for, and detection of, fetuses at risk for developing late FGR [4][5][6][7][8] .…”

Section: Introductionmentioning

confidence: 99%

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

Sotiriadis

Figueras

Eleftheriades

et al. 2018

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