Small‐for‐gestational‐age babies after 37 weeks: impact study of risk‐stratification protocol

Veglia, Manuela; Cavallaro, A; Papageorghiou, Aris T.; Black, Rebecca; Impey, Lawrence

doi:10.1002/uog.17544

Cited by 34 publications

(45 citation statements)

References 37 publications

(42 reference statements)

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“…Interestingly, a study comparing routine induction at 37 weeks for all SGA detected cases with selective induction only for those classified as FGR according to the previously mentioned criteria (EFW <3rd centile, CPR and UtA) showed not only less intervention (cesarean delivery rate of 25% of 143 vs 40% 138; P < .06) but also improved neonatal outcomes (composite neonatal morbidity of 9% vs 22%; P < .01). 94 In this series, the qualifying criteria for FGR were EFW <3rd centile in 35.9% (101/ 281), an abnormal uterine Doppler velocimetry in 31% (29/93), an abnormal CPR in 19.6% (55/281), and first-trimester low pregnancy-associated plasma protein-A in the remaining 5% (14/281).…”

Section: Doppler Parametersmentioning

confidence: 73%

“…87 In late SGA fetuses, CPR becomes abnormal in w20% of cases. 5,94 The CPR improves the sensitivity of UA and MCA alone, because it is already decreased when its individual components are still within normal ranges. 87,88 A recent systematic review 90 found that in fetuses with SGA born >32 weeks of gestational age, CPR (9 studies) adds value to assessment over MCA (8 studies) in predicting adverse outcomes.…”

Section: Brain Dopplermentioning

confidence: 99%

See 1 more Smart Citation

Diagnosis and surveillance of late-onset fetal growth restriction

Figueras

Caradeux²,

Crispi³

et al. 2018

American Journal of Obstetrics and Gynecology

219

172

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Section: Doppler Parametersmentioning

confidence: 73%

Section: Brain Dopplermentioning

confidence: 99%

Diagnosis and surveillance of late-onset fetal growth restriction

Figueras

Caradeux²,

Crispi³

et al. 2018

American Journal of Obstetrics and Gynecology

219

172

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“…As SGA is just one manifestation of FGR, even the universal detection of SGA will have limited effects on stillbirth and neonatal morbidity. As some SGA fetuses are constitutionally small, and probably not at increased perinatal risk, iatrogenic delivery may be harmful. It is therefore important to identify other predictors of adverse outcome.…”

Section: Discussionmentioning

confidence: 99%

“…The CPR was expressed as a centile for gestational age according to Baschat–Gembruch charts. Established cut‐offs of EFW, ACGV and CPR were used.…”

Section: Methodsmentioning

confidence: 99%

Using fetal abdominal circumference growth velocity in the prediction of adverse outcome in near‐term small‐for‐gestational‐age fetuses

Cavallaro

Veglia

Svirko

et al. 2018

Ultrasound in Obstet & Gyne

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“…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

Ultrasound in Obstet & Gyne

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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.

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Small‐for‐gestational‐age babies after 37 weeks: impact study of risk‐stratification protocol

Cited by 34 publications

References 37 publications

Diagnosis and surveillance of late-onset fetal growth restriction

Diagnosis and surveillance of late-onset fetal growth restriction

Using fetal abdominal circumference growth velocity in the prediction of adverse outcome in near‐term small‐for‐gestational‐age fetuses

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

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