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Triunfo S, Crispi F, Gratacos E, Figueras F. Prediction of delivery of small-for-gestational-age neonates and adverse perinatal outcome by fetoplacental Doppler at 37 weeks' gestation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:364-371. [PMID: 27241184 DOI: 10.1002/uog.15979] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 05/05/2016] [Accepted: 05/23/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To explore the predictive capacity of fetoplacental Doppler at 37 weeks' gestation in identifying small-for-gestational-age (SGA) neonates, fetal growth restriction (FGR) and adverse perinatal outcome. METHODS This was a prospective cohort study of low-risk singleton pregnancies undergoing ultrasound assessment at 37 weeks. At study inclusion, biometry for estimated fetal weight (EFW), and fetoplacental Doppler variables (uterine artery pulsatility index (UtA-PI), cerebroplacental ratio (CPR) and umbilical vein blood flow (UVBF) normalized by EFW) were measured. SGA was defined as a customized birth weight between the 3rd and 10th centiles, and FGR was defined as a birth weight < 3rd centile, according to local standards. Adverse perinatal outcomes included emergency Cesarean section for non-reassuring fetal status, 5-min Apgar score < 7 and neonatal acidosis at birth. RESULTS A total of 946 pregnancies were included in the study. Of these, 89 (9.4%) were classified as SGA and 40 (4.2%) as FGR, with an overall rate of adverse perinatal outcome of 4.9%. At a fixed 10% false-positive rate (FPR), the detection rate of SGA by EFW, UtA-PI, CPR, UVBF and by a combination of Doppler variables (UtA-PI and CPR) and EFW was 59.2%, 10.5%, 13.7%, 3.2% and 61.0%, respectively. At a fixed 10% FPR, the detection rate of FGR by EFW, UtA-PI, CPR, UVBF and a combination of CPR and EFW centile was 83.3%, 13.9%, 27.8%, 13.9% and 88.6%, respectively. At a fixed 10% FPR, the detection rate of adverse perinatal outcome by EFW, UtA-PI, CPR and UVBF was 19.2%, 9.2%, 23.1% and 16.9%, respectively, while combining EFW with Doppler variables (including CPR and UVBF normalized by EFW) improved the detection rate to nearly 30%. CONCLUSION In low-risk pregnancies, Doppler evaluation at 37 weeks' gestation did not improve the prediction of SGA and FGR compared with that given by EFW alone, however, combining Doppler variables with EFW improved the prediction of adverse perinatal outcomes given by these parameters alone, although not markedly. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- S Triunfo
- Fetal i + D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Center for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - F Crispi
- Fetal i + D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Center for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - E Gratacos
- Fetal i + D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Center for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - F Figueras
- Fetal i + D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Center for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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MacDonald TM, Kaitu'u-Lino TJ, Walker SP, Dane KM, Lockie EB, Tong S, Whitehead CL, Hui L. Variable effect of maternal oral glucose load on circulating cell-free placental mRNAs. J Matern Fetal Neonatal Med 2017; 30:501-503. [PMID: 27073013 DOI: 10.1080/14767058.2016.1177815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND It is not known whether fasting affects levels of circulating placenta-specific transcripts. OBJECTIVE To assess whether a glucose load affects circulating placenta-specific transcripts. METHOD RNA was extracted from paired blood samples (fasting and 1-h post 75 g oral glucose) from 22 women. Placenta-specific genes were measured by RT-qPCR. RESULTS There was no change in ADM, CSH1, PAPPA2, PSG1 or TAC3 expression between fasting and post-glucose states. However, HTRA1 decreased after glucose load. CONCLUSION Maternal fasting state does not influence expression of the majority of placenta-specific genes but may need to be accounted for when validating biomarkers of placental disease.
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Affiliation(s)
- Teresa Mary MacDonald
- a Translational Obstetrics Group, Mercy Hospital for Women , Melbourne , Heidelberg , Australia
- b Department of Obstetrics and Gynaecology , The University of Melbourne , Melbourne , Australia , and
- c Perinatal Department, Mercy Hospital for Women , Melbourne , Heidelberg , Australia
| | - Tu'uhevaha Joy Kaitu'u-Lino
- a Translational Obstetrics Group, Mercy Hospital for Women , Melbourne , Heidelberg , Australia
- b Department of Obstetrics and Gynaecology , The University of Melbourne , Melbourne , Australia , and
| | - Susan Philippa Walker
- b Department of Obstetrics and Gynaecology , The University of Melbourne , Melbourne , Australia , and
- c Perinatal Department, Mercy Hospital for Women , Melbourne , Heidelberg , Australia
| | - Kirsten Margaret Dane
- c Perinatal Department, Mercy Hospital for Women , Melbourne , Heidelberg , Australia
| | - Elizabeth Beatrice Lockie
- b Department of Obstetrics and Gynaecology , The University of Melbourne , Melbourne , Australia , and
- c Perinatal Department, Mercy Hospital for Women , Melbourne , Heidelberg , Australia
| | - Stephen Tong
- a Translational Obstetrics Group, Mercy Hospital for Women , Melbourne , Heidelberg , Australia
- b Department of Obstetrics and Gynaecology , The University of Melbourne , Melbourne , Australia , and
| | - Clare Louise Whitehead
- a Translational Obstetrics Group, Mercy Hospital for Women , Melbourne , Heidelberg , Australia
| | - Lisa Hui
- a Translational Obstetrics Group, Mercy Hospital for Women , Melbourne , Heidelberg , Australia
- b Department of Obstetrics and Gynaecology , The University of Melbourne , Melbourne , Australia , and
- c Perinatal Department, Mercy Hospital for Women , Melbourne , Heidelberg , Australia
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Crovetto F, Triunfo S, Crispi F, Rodriguez-Sureda V, Dominguez C, Figueras F, Gratacos E. Differential performance of first-trimester screening in predicting small-for-gestational-age neonate or fetal growth restriction. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:349-356. [PMID: 26990232 DOI: 10.1002/uog.15919] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 01/29/2016] [Accepted: 03/09/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To assess the ability of integrated first-trimester screening, combining maternal characteristics and biophysical and biochemical markers, to predict delivery of a small-for-gestational-age (SGA) neonate, and compare this with its ability to predict fetal growth restriction (FGR). METHODS This was a prospective cohort study of singleton pregnancies undergoing routine first-trimester screening. SGA was defined as birth weight (BW) < 10th percentile and FGR was defined as an ultrasound estimated fetal weight < 10th percentile plus Doppler abnormalities, or BW < 3rd percentile. Logistic regression-based predictive models were developed for predicting SGA and FGR. Models incorporated the a-priori risk from maternal characteristics, and mean arterial pressure, uterine artery Doppler, placental growth factor and soluble fms-like tyrosine kinase-1. RESULTS In total, 9150 births were included. Of these, 979 (10.7%) qualified for a postnatal diagnosis of SGA and 462 (5.0%) for a prenatal diagnosis of FGR. For predicting SGA, the model achieved a detection rate of 35% for a false-positive rate (FPR) of 5% and 42% for a 10% FPR. The model's performance was significantly higher for predicting FGR (P < 0.001), with detection rates of 59% and 67%, for a FPR of 5% and 10%, respectively. CONCLUSION The predictive performance of first-trimester screening for cases with growth impairment by a combination of maternal characteristics and biophysical and biochemical markers is improved significantly when a prenatal and strict definition of FGR is used rather than a postnatal definition based on BW. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F Crovetto
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
- Department of Obstetrics and Gynecology, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - S Triunfo
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - F Crispi
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - V Rodriguez-Sureda
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
- Biochemistry and Molecular Biology Research Centre for Nanomedicine, Hospital Universitari Vall d'Hebron, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - C Dominguez
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
- Biochemistry and Molecular Biology Research Centre for Nanomedicine, Hospital Universitari Vall d'Hebron, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - F Figueras
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - E Gratacos
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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Prediction of Small for Gestational Age Infants in Healthy Nulliparous Women Using Clinical and Ultrasound Risk Factors Combined with Early Pregnancy Biomarkers. PLoS One 2017; 12:e0169311. [PMID: 28068394 PMCID: PMC5221822 DOI: 10.1371/journal.pone.0169311] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/14/2016] [Indexed: 11/19/2022] Open
Abstract
Objective Most small for gestational age pregnancies are unrecognised before birth, resulting in substantial avoidable perinatal mortality and morbidity. Our objective was to develop multivariable prediction models for small for gestational age combining clinical risk factors and biomarkers at 15±1 weeks’ with ultrasound parameters at 20±1 weeks’ gestation. Methods Data from 5606 participants in the Screening for Pregnancy Endpoints (SCOPE) cohort study were divided into Training (n = 3735) and Validation datasets (n = 1871). The primary outcomes were All-SGA (small for gestational age with birthweight <10th customised centile), Normotensive-SGA (small for gestational age with a normotensive mother) and Hypertensive-SGA (small for gestational age with an hypertensive mother). The comparison group comprised women without the respective small for gestational age phenotype. Multivariable analysis was performed using stepwise logistic regression beginning with clinical variables, and subsequent additions of biomarker and then ultrasound (biometry and Doppler) variables. Model performance was assessed in Training and Validation datasets by calculating area under the curve. Results 633 (11.2%) infants were All-SGA, 465(8.2%) Normotensive-SGA and 168 (3%) Hypertensive-SGA. Area under the curve (95% Confidence Intervals) for All-SGA using 15±1 weeks’ clinical variables, 15±1 weeks’ clinical+ biomarker variables and clinical + biomarkers + biometry /Doppler at 20±1 weeks’ were: 0.63 (0.59–0.67), 0.64 (0.60–0.68) and 0.69 (0.66–0.73) respectively in the Validation dataset; Normotensive-SGA results were similar: 0.61 (0.57–0.66), 0.61 (0.56–0.66) and 0.68 (0.64–0.73) with small increases in performance in the Training datasets. Area under the curve (95% Confidence Intervals) for Hypertensive-SGA were: 0.76 (0.70–0.82), 0.80 (0.75–0.86) and 0.84 (0.78–0.89) with minimal change in the Training datasets. Conclusion Models for prediction of small for gestational age, which combine biomarkers, clinical and ultrasound data from a cohort of low-risk nulliparous women achieved modest performance. Incorporation of biomarkers into the models resulted in no improvement in performance of prediction of All-SGA and Normotensive-SGA but a small improvement in prediction of Hypertensive-SGA. Our models currently have insufficient reliability for application in clinical practice however, they have potential utility in two-staged screening tests which include third trimester biomarkers and or fetal biometry.
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Pay ASD, Frøen JF, Staff AC, Jacobsson B, Gjessing HK. Symfyse-fundus-mål – prediktiv verdi av ny referansekurve. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2017; 137:717-720. [DOI: 10.4045/tidsskr.16.1022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Khalil A, Thilaganathan B. Role of uteroplacental and fetal Doppler in identifying fetal growth restriction at term. Best Pract Res Clin Obstet Gynaecol 2017; 38:38-47. [DOI: 10.1016/j.bpobgyn.2016.09.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 09/16/2016] [Indexed: 01/31/2023]
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Lindqvist PG, Landin-Olsson M. The relationship between sun exposure and all-cause mortality. Photochem Photobiol Sci 2017; 16:354-361. [DOI: 10.1039/c6pp00316h] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Women with low sun exposure are at a dose-dependently increased risk of all-cause mortality, mainly due to an increased risk of death from cardiovascular or noncancer/noncardiovascular disease compared higher exposure.
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Affiliation(s)
- Pelle G. Lindqvist
- Clintec Karolinska Institutet
- Department of obstetrics and Gynecology K57
- Karolinska University Hospital
- Huddinge
- Sweden
| | - Mona Landin-Olsson
- Clinical Sciences
- Department of endocrinology
- Lund University Hospital
- Lund
- Sweden
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208
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Zhao M, Dai H, Deng Y, Zhao L. SGA as a Risk Factor for Cerebral Palsy in Moderate to Late Preterm Infants: a System Review and Meta-analysis. Sci Rep 2016; 6:38853. [PMID: 27958310 PMCID: PMC5153647 DOI: 10.1038/srep38853] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 11/11/2016] [Indexed: 11/09/2022] Open
Abstract
Small for gestational age (SGA) is an established risk factor for cerebral palsy (CP) in term infants. However, there is conflicting data on the association between SGA and CP in moderate to late preterm infants. The aim of the article was to explore the relationship between SGA and CP in the moderate to late preterm infants and its strength by meta-analysis. We performed a system search in OVID (EMBASE and MEDLINE) and WANFANG from inception to May 2016. The study-specific risk estimates were pooled using the random-effect model. A total of seven studies were included in the meta-analysis, consisting of three cohort and four case-control studies. A statistically significant association was found between SGA and CP in moderate to late premature infants (OR: 2.34; 95% CI: 1.43-3.82). The association were higher in the several subgroups: 34-36 week gestational age (OR: 3.47; 95% CI: 1.29-9.31), SGA < 2SDs (OR: 3.48; 95% CI: 1.86-6.49), and malformation included in CP (OR: 3.00; 95% CI: 1.71-5.26). In moderate to late premature infants, SGA is a convenient and reliable predictor for CP. More studies are needed to explore the underlying mechanisms between SGA and CP association.
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Affiliation(s)
- Mengwen Zhao
- Department of Pediatrics, the Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Hongmei Dai
- Department of Pediatrics, the Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Yuanying Deng
- Department of Pediatrics, the Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Lingling Zhao
- Department of Pediatrics, the Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
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Shinohara S, Uchida Y, Hirai M, Hirata S, Suzuki K. Relationship between maternal hypoglycaemia and small-for-gestational-age infants according to maternal weight status: a retrospective cohort study in two hospitals. BMJ Open 2016; 6:e013749. [PMID: 27913562 PMCID: PMC5168595 DOI: 10.1136/bmjopen-2016-013749] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The relationship between pre-pregnancy body mass index (BMI) and low glucose challenge test (GCT) results by maternal weight status has not been examined. This study aimed to clarify the relationship between a low GCT result and small for gestational age (SGA) by maternal weight status. DESIGN A retrospective cohort study in 2 hospitals. SETTING This study evaluated the obstetric records of women who delivered in a general community hospital and a tertiary perinatal care centre. PARTICIPANTS The number of women who delivered in both hospitals between January 2012 and December 2013 and underwent GCT between 24 and 28 weeks of gestation was 2140. Participants with gestational diabetes mellitus or diabetes during pregnancy, and GCT results of ≥140 mg/dL were excluded. Finally, 1860 women were included in the study. PRIMARY AND SECONDARY OUTCOME MEASURES The participants were divided into low-GCT (≤90 mg/dL) and non-low-GCT groups (91-139 mg/dL). The χ2 tests and multivariate logistic regression analyses were conducted to investigate the association between low GCT results and SGA by maternal weight status. RESULTS The incidence of SGA was 11.4% (212/1860), and 17.7% (330/1860) of the women showed low GCT results. The patients were divided into 3 groups according to their BMI (underweight, normal weight and obese). When the patients were analysed separately by their weight status after controlling for maternal age, pre-pregnancy maternal weight, maternal weight gain during pregnancy, pregnancy-induced hypertension, thyroid disease and difference in hospital, low GCT results were significantly associated with SGA (OR 2.10; 95% CI 1.14 to 3.89; p=0.02) in the underweight group. CONCLUSIONS Low GCT result was associated with SGA at birth among underweight women. Examination of maternal glucose tolerance and fetal growth is necessary in future investigations.
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Affiliation(s)
- Satoshi Shinohara
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, Kofu, Japan
| | - Yuzo Uchida
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, Kofu, Japan
| | - Mitsuo Hirai
- Department of Obstetrics and Gynecology, Kofu Municipal Hospital, Kofu, Japan
| | - Shuji Hirata
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Yamanashi, Chuo, Japan
| | - Kohta Suzuki
- Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Yazakokarimata, Japan
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Kaijomaa M, Ulander VM, Ryynanen M, Stefanovic V. Risk of Adverse Outcomes in Euploid Pregnancies With Isolated Short Fetal Femur and Humerus on Second-Trimester Sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2675-2680. [PMID: 27872421 DOI: 10.7863/ultra.16.01086] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 02/26/2016] [Accepted: 03/26/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate pregnancies with isolated short fetal femur and humerus on second-trimester sonography. Short fetal long bones are known to be associated with aneuploidy and structural anomalies. In this study, we wanted to show the risk of adverse pregnancy outcomes in euploid and nonanomalous pregnancies. METHODS Singleton pregnancies with short femur and humerus were included. Pregnancies with normal fetal bone lengths and age-matched mothers were selected as controls. RESULTS The study group included 30 pregnancies with short fetal femur and humerus, and the control group included 60 normal pregnancies. The overall odds ratio for an adverse pregnancy outcome in the study group was 24.9. Preterm delivery occurred significantly more frequently (odds ratio, 20.8; P < .001), and one-third of pregnancies were complicated by preeclampsia. In the group with short long bones, the odds ratio for a pathologic umbilical Doppler flow pattern was 45.2 (P < .001), and birth weight was significantly lower (P < .001). Also, 3 (10.3%) stillbirths and 4 (13.3%) cases of early neonatal death were recorded in this group. These complications were not recorded in the control group. The risk of emergency cesarean delivery was significantly higher in the group with short long bones (odds ratio, 11.8; P < .001). CONCLUSIONS The risk of adverse pregnancy outcomes is significant in euploid and nonanomalous pregnancies with isolated short long bones. Close follow-up is needed during pregnancy.
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Affiliation(s)
- Marja Kaijomaa
- Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Veli-Matti Ulander
- Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Markku Ryynanen
- Department of Obstetrics and Gynecology, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Vedran Stefanovic
- Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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Sinding M, Peters DA, Frøkjær JB, Christiansen OB, Petersen A, Uldbjerg N, Sørensen A. Prediction of low birth weight: Comparison of placental T2* estimated by MRI and uterine artery pulsatility index. Placenta 2016; 49:48-54. [PMID: 28012454 DOI: 10.1016/j.placenta.2016.11.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/03/2016] [Accepted: 11/21/2016] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Neonates at low birth weight due to placental dysfunction are at high risk of adverse outcomes. These outcomes can be substantially improved by prenatal identification. The Magnetic Resonance Imaging (MRI) constant, placental T2* reflects placental structure and oxygenation and thereby placental function. Therefore, we aimed to evaluate the performance of placental T2* in the prediction of low birth weight using the uterine artery (UtA) pulsatility index (PI) as gold standard. METHODS This was a prospective observational study of 100 singleton pregnancies included at 20-40 weeks' gestation. Placental T2* was obtained using a gradient recalled multi-echo MRI sequence and UtA PI was measured using Doppler ultrasound. Placental pathological examination was performed in 57 of the pregnancies. Low birth weight was defined by a Z-score ≤ -2.0. RESULTS The incidence of low birth weight was 15%. The median time interval between measurements and birth was 7.3 weeks (interquartile range 3.0, 13.7 weeks). Linear regression revealed significant associations between birth weight Z-score and both placental T2* Z-score (r = 0.68, p < 0.0001) and UtA PI Z-score (r = -0.43, p < 0.0001). Receiver operating characteristic curves demonstrated a significantly higher performance of T2* (AUC of 0.92; 95% CI, 0.85-0.98) than UtA PI (AUC of 0.74; 95% CI, 0.60-0.89) in the prediction of low birth weight (p = 0.010). Placental pathological findings were closely related to the T2* values. CONCLUSIONS In this population, placental T2* was a strong predictor of low birth weight and it performed significantly better than the UtA PI. Thus, placental T2* is a promising marker of placental dysfunction which deserves further investigation.
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Affiliation(s)
- Marianne Sinding
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbansgade 15, 9000 Aalborg, Denmark.
| | - David A Peters
- Department of Clinical Engineering, Central Denmark Region, Olof Palmes Alle 13, 8200 Aarhus N, Denmark.
| | - Jens B Frøkjær
- Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, 9100 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University Hospital, Sdr. Skovvej 15, 9000 Aalborg, Denmark.
| | - Ole B Christiansen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbansgade 15, 9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University Hospital, Sdr. Skovvej 15, 9000 Aalborg, Denmark.
| | - Astrid Petersen
- Department of Pathology, Aalborg University Hospital, Reberbansgade 15, 9000 Aalborg, Denmark.
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul - Jensens Boulevard 99, 8200 Aarhus N, Denmark.
| | - Anne Sørensen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbansgade 15, 9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University Hospital, Sdr. Skovvej 15, 9000 Aalborg, Denmark.
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Tarca AL, Hernandez-Andrade E, Ahn H, Garcia M, Xu Z, Korzeniewski SJ, Saker H, Chaiworapongsa T, Hassan SS, Yeo L, Romero R. Single and Serial Fetal Biometry to Detect Preterm and Term Small- and Large-for-Gestational-Age Neonates: A Longitudinal Cohort Study. PLoS One 2016; 11:e0164161. [PMID: 27802270 PMCID: PMC5089737 DOI: 10.1371/journal.pone.0164161] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 09/20/2016] [Indexed: 11/24/2022] Open
Abstract
Objectives To assess the value of single and serial fetal biometry for the prediction of small- (SGA) and large-for-gestational-age (LGA) neonates delivered preterm or at term. Methods A cohort study of 3,971 women with singleton pregnancies was conducted from the first trimester until delivery with 3,440 pregnancies (17,334 scans) meeting the following inclusion criteria: 1) delivery of a live neonate after 33 gestational weeks and 2) two or more ultrasound examinations with fetal biometry parameters obtained at ≤36 weeks. Primary outcomes were SGA (<5th centile) and LGA (>95th centile) at birth based on INTERGROWTH-21st gender-specific standards. Fetus-specific estimated fetal weight (EFW) trajectories were calculated by linear mixed-effects models using data up to a fixed gestational age (GA) cutoff (28, 32, or 36 weeks) for fetuses having two or more measurements before the GA cutoff and not already delivered. A screen test positive for single biometry was based on Z-scores of EFW at the last scan before each GA cut-off so that the false positive rate (FPR) was 10%. Similarly, a screen test positive for the longitudinal analysis was based on the projected (extrapolated) EFW at 40 weeks from all available measurements before each cutoff for each fetus. Results Fetal abdominal and head circumference measurements, as well as birth weights in the Detroit population, matched well to the INTERGROWTH-21st standards, yet this was not the case for biparietal diameter (BPD) and femur length (FL) (up to 9% and 10% discrepancy for mean and confidence intervals, respectively), mainly due to differences in the measurement technique. Single biometry based on EFW at the last scan at ≤32 weeks (GA IQR: 27.4–30.9 weeks) had a sensitivity of 50% and 53% (FPR = 10%) to detect preterm and term SGA and LGA neonates, respectively (AUC of 82% both). For the detection of LGA using data up to 32- and 36-week cutoffs, single biometry analysis had higher sensitivity than longitudinal analysis (52% vs 46% and 62% vs 52%, respectively; both p<0.05). Restricting the analysis to subjects with the last observation taken within two weeks from the cutoff, the sensitivity for detection of LGA, but not SGA, increased to 65% and 72% for single biometry at the 32- and 36-week cutoffs, respectively. SGA screening performance was higher for preterm (<37 weeks) than for term cases (73% vs 46% sensitivity; p<0.05) for single biometry at ≤32 weeks. Conclusions When growth abnormalities are defined based on birth weight, growth velocity (captured in the longitudinal analysis) does not provide additional information when compared to the last measurement for predicting SGA and LGA neonates, with both approaches detecting one-half of the neonates (FPR = 10%) from data collected at ≤32 weeks. Unlike for SGA, LGA detection can be improved if ultrasound scans are scheduled as close as possible to the gestational-age cutoff when a decision regarding the clinical management of the patient needs to be made. Screening performance for SGA is higher for neonates that will be delivered preterm.
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Affiliation(s)
- Adi L. Tarca
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- Department of Computer Science, Wayne State University College of Engineering, Detroit, Michigan, United States of America
- * E-mail: (RR); (ALT)
| | - Edgar Hernandez-Andrade
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Hyunyoung Ahn
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Maynor Garcia
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Zhonghui Xu
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, and Detroit, Michigan, United States of America
| | - Steven J. Korzeniewski
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, United States of America
| | - Homam Saker
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Sonia S. Hassan
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Lami Yeo
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Roberto Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, and Detroit, Michigan, United States of America
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, United States of America
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, United States of America
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, United States of America
- * E-mail: (RR); (ALT)
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Measuring circulating placental RNAs to non-invasively assess the placental transcriptome and to predict pregnancy complications. Prenat Diagn 2016; 36:997-1008. [DOI: 10.1002/pd.4934] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/08/2016] [Accepted: 09/30/2016] [Indexed: 11/07/2022]
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Figueras F, Gratacos E. An integrated approach to fetal growth restriction. Best Pract Res Clin Obstet Gynaecol 2016; 38:48-58. [PMID: 27940123 DOI: 10.1016/j.bpobgyn.2016.10.006] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 10/04/2016] [Accepted: 10/10/2016] [Indexed: 01/08/2023]
Abstract
Fetal growth restriction (FGR) is among the most common complications of pregnancy. FGR is associated with placental insufficiency and poor perinatal outcomes. Clinical management is challenging because of variability in clinical presentation. Fetal smallness (estimated fetal weight <10th centile for gestational age) remains the best clinical surrogate for FGR. However, it is commonly accepted that not all forms of fetal smallness represent true FGR. In a significant subset of small fetuses, there is no evidence of placental involvement, perinatal outcomes are nearly normal, and they are clinically referred to as "only" small for gestational age (SGA). Doppler may improve the clinical management of FGR; however, the need to use several parameters sometimes results in a number of combinations that may render interpretation challenging when translating into clinical decisions. We propose that the management of FGR can be simplified using a sequential approach based on three steps: (1) identification of the "small fetus," (2) differentiation between FGR and SGA, and (3) timing of delivery according to a protocol based on stages of fetal deterioration.
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Affiliation(s)
- Francesc Figueras
- Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, Spain; Centre for Biomedical Research on Rare Diseases (CIBER-ER), Spain
| | - Eduard Gratacos
- Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, Spain; Centre for Biomedical Research on Rare Diseases (CIBER-ER), Spain.
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215
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Monaghan C, Thilaganathan B. Fetal Growth Restriction (FGR): How the Differences Between Early and Late FGR Impact on Clinical Management? JOURNAL OF FETAL MEDICINE 2016. [DOI: 10.1007/s40556-016-0098-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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216
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Crovetto F, Triunfo S, Crispi F, Rodriguez-Sureda V, Roma E, Dominguez C, Gratacos E, Figueras F. First-trimester screening with specific algorithms for early- and late-onset fetal growth restriction. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:340-348. [PMID: 26846589 DOI: 10.1002/uog.15879] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 12/23/2015] [Accepted: 01/30/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To develop optimal first-trimester algorithms for the prediction of early and late fetal growth restriction (FGR). METHODS This was a prospective cohort study of singleton pregnancies undergoing first-trimester screening. FGR was defined as an ultrasound estimated fetal weight < 10(th) percentile plus Doppler abnormalities or a birth weight < 3(rd) percentile. Logistic regression-based predictive models were developed for predicting early and late FGR (cut-off: delivery at 34 weeks). The model included the a-priori risk (maternal characteristics), mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1). RESULTS Of the 9150 pregnancies included, 462 (5%) fetuses were growth restricted: 59 (0.6%) early and 403 (4.4%) late. Significant contributions to the prediction of early FGR were provided by black ethnicity, chronic hypertension, previous FGR, MAP, UtA-PI, PlGF and sFlt-1. The model achieved an overall detection rate (DR) of 86.4% for a 10% false-positive rate (area under the receiver-operating characteristics curve (AUC): 0.93 (95% CI, 0.87-0.98)). The DR was 94.7% for FGR with pre-eclampsia (PE) (64% of cases) and 71.4% for FGR without PE (36% of cases). For late FGR, significant contributions were provided by chronic hypertension, autoimmune disease, previous FGR, smoking status, nulliparity, MAP, UtA-PI, PlGF and sFlt-1. The model achieved a DR of 65.8% for a 10% false-positive rate (AUC: 0.76 (95% CI, 0.73-0.80)). The DR was 70.2% for FGR with PE (12% of cases) and 63.5% for FGR without PE (88% of cases). CONCLUSIONS The optimal screening algorithm was different for early vs late FGR, supporting the concept that screening for FGR is better performed separately for the two clinical forms. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F Crovetto
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
- Department of Obstetrics and Gynecology, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - S Triunfo
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - F Crispi
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - V Rodriguez-Sureda
- Biochemistry and Molecular Biology Research Centre for Nanomedicine, Hospital Universitari Vall d'Hebron, and Centre for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain
| | - E Roma
- Obstetrics and Gynecology Department, Althaia, Network Healthcare Manresa Foundation, Barcelona, Spain
| | - C Dominguez
- Biochemistry and Molecular Biology Research Centre for Nanomedicine, Hospital Universitari Vall d'Hebron, and Centre for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain
| | - E Gratacos
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - F Figueras
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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Domínguez Vigo P, Álvarez Silvares E, Alves Pérez M, Vázquez Rodríguez M, Pérez Adán M. Retraso de crecimiento intrauterino severo: ¿es posible su cribado en el primer trimestre de gestación? CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2016. [DOI: 10.1016/j.gine.2015.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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218
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Whitehead CL, McNamara H, Walker SP, Alexiadis M, Fuller PJ, Vickers DK, Hannan NJ, Hastie R, Tuohey L, Kaitu'u-Lino TJ, Tong S. Identifying late-onset fetal growth restriction by measuring circulating placental RNA in the maternal blood at 28 weeks' gestation. Am J Obstet Gynecol 2016; 214:521.e1-521.e8. [PMID: 26880734 DOI: 10.1016/j.ajog.2016.01.191] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 01/22/2016] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Late-onset fetal growth restriction (FGR) is often undetected prior to birth, which puts the fetus at increased risk of adverse perinatal outcomes including stillbirth. OBJECTIVE Measuring RNA circulating in the maternal blood may provide a noninvasive insight into placental function. We examined whether measuring RNA in the maternal blood at 26-30 weeks' gestation can identify pregnancies at risk of late-onset FGR. We focused on RNA highly expressed in placenta, which we termed "placental-specific genes." STUDY DESIGN This was a case-control study nested within a prospective cohort of 600 women recruited at 26-30 weeks' gestation. The circulating placental transcriptome in maternal blood was compared between women with late-onset FGR (<5th centile at >36+6 weeks) and gestation-matched well-grown controls (20-95th centile) using microarray (n = 12). TaqMan low-density arrays, reverse transcription-polymerase chain reaction (PCR), and digital PCR were used to validate the microarray findings (FGR n = 40, controls n = 80). RESULTS Forty women developed late-onset FGR (birthweight 2574 ± 338 g, 2nd centile) and were matched to 80 well-grown controls (birthweight 3415 ± 339 g, 53rd centile, P < .05). Operative delivery and neonatal admission were higher in the FGR cohort (45% vs 23%, P < .05). Messenger RNA coding 137 placental-specific genes was detected in the maternal blood and 37 were differentially expressed in late-onset FGR. Seven were significantly dysregulated with PCR validation (P < .05). Activating transcription factor-3 messenger RNA transcripts were the most promising single biomarker at 26-30 weeks: they were increased in fetuses destined to be born FGR at term (2.1-fold vs well grown at term, P < .001) and correlated with the severity of FGR. Combining biomarkers improved prediction of severe late-onset FGR (area under the curve, 0.88; 95% CI 0.80-0.97). A multimarker gene expression score had a sensitivity of 79%, a specificity of 88%, and a positive likelihood ratio of 6.2 for subsequent delivery of a baby <3rd centile at term. CONCLUSION A unique placental transcriptome is detectable in maternal blood at 26-30 weeks' gestation in pregnancies destined to develop late-onset FGR. Circulating placental RNA may therefore be a promising noninvasive test to identify pregnancies at risk of developing FGR at term.
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219
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Hammad IA, Chauhan SP, Mlynarczyk M, Rabie N, Goodie C, Chang E, Magann EF, Abuhamad AZ. Uncomplicated Pregnancies and Ultrasounds for Fetal Growth Restriction: A Pilot Randomized Clinical Trial. AJP Rep 2016; 6:e83-90. [PMID: 26929878 PMCID: PMC4737635 DOI: 10.1055/s-0035-1567857] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 10/01/2015] [Indexed: 11/15/2022] Open
Abstract
Objective The purpose of this multicenter pilot study was to determine the feasibility of randomizing uncomplicated pregnancies (UPs) to have third trimester ultrasonographic exams (USE) versus routine prenatal care (RPNC) to improve the detection of small for gestational age (SGA; birth weight < 10% for GA). Material and Methods At three referral centers, 50 UPs were randomized after gestational diabetes was ruled out. Women needed to screen, consenting, and loss to follow-up was ascertained, as was the detection rate of SGA in the two groups. Results During the study period at the three centers, there were 7,680 births, of which 64% were uncomplicated. Of the 234 women approached for randomization, 36% declined. We recruited 149 women and had follow-up delivery data on 97%. The antenatal detection rate of SGA in the intervention group was 67% (95% confidence intervals 31-91%) and 9% (0.5-43%) in control. Conclusion The pilot study provides feasibility data for a multicenter randomized clinical trial to determine if third trimester USE, compared with RPNC, improves the detection of SGA and composite neonatal morbidity.
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Affiliation(s)
- Ibrahim A. Hammad
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Suneet P. Chauhan
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, UT Health Science Center, Houston, Texas
| | - Malgorzata Mlynarczyk
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Nader Rabie
- Department of Obstetrics and Gynecology, University of Arkansas for the Medical Sciences, Little Rock, Arkansas
| | - Chris Goodie
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
| | - Eugene Chang
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
| | - Everett F. Magann
- Department of Obstetrics and Gynecology, University of Arkansas for the Medical Sciences, Little Rock, Arkansas
| | - Alfred Z. Abuhamad
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
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Jadli A, Ghosh K, Shetty S. Prediction of small-for-gestational-age at 35-37 weeks of gestation: too late for management? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:385. [PMID: 26940676 DOI: 10.1002/uog.15739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 08/26/2015] [Indexed: 06/05/2023]
Affiliation(s)
- A Jadli
- Department of Haemostasis Thrombosis, National Institute of Immunohaematology (ICMR), Mumbai, 400012, India
| | - K Ghosh
- Department of Haemostasis Thrombosis, National Institute of Immunohaematology (ICMR), Mumbai, 400012, India
| | - S Shetty
- Department of Haemostasis Thrombosis, National Institute of Immunohaematology (ICMR), Mumbai, 400012, India
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Ego A, Prunet C, Lebreton E, Blondel B, Kaminski M, Goffinet F, Zeitlin J. Courbes de croissance in utero ajustées et non ajustées adaptées à la population française. I – Méthodes de construction. ACTA ACUST UNITED AC 2016; 45:155-64. [DOI: 10.1016/j.jgyn.2015.08.009] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/13/2015] [Accepted: 08/25/2015] [Indexed: 11/28/2022]
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Bardien N, Whitehead CL, Tong S, Ugoni A, McDonald S, Walker SP. Placental Insufficiency in Fetuses That Slow in Growth but Are Born Appropriate for Gestational Age: A Prospective Longitudinal Study. PLoS One 2016; 11:e0142788. [PMID: 26730589 PMCID: PMC4701438 DOI: 10.1371/journal.pone.0142788] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 10/27/2015] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To determine whether fetuses that slow in growth but are then born appropriate for gestational age (AGA, birthweight >10th centile) demonstrate ultrasound and clinical evidence of placental insufficiency. METHODS Prospective longitudinal study of 48 pregnancies reaching term and a birthweight >10th centile. We estimated fetal weight by ultrasound at 28 and 36 weeks, and recorded birthweight to determine the relative change in customised weight across two timepoints: 28-36 weeks and 28 weeks-birth. The relative change in weight centiles were correlated with fetoplacental Doppler findings performed at 36 weeks. We also examined whether a decline in growth trajectory in fetuses born AGA was associated with operative deliveries performed for suspected intrapartum compromise. RESULTS The middle cerebral artery pulsatility index (MCA-PI) showed a linear association with fetal growth trajectory. Lower MCA-PI readings (reflecting greater diversion of blood supply to the brain) were significantly associated with a decline in fetal growth, both between 28-36 weeks (p = 0.02), and 28 weeks-birth (p = 0.0002). The MCA-PI at 36 weeks was significantly higher among those with a relative weight centile fall <20%, compared to those with a moderate centile fall of 20-30% (mean MCA-PI 1.94 vs 1.61; p<0.05), or severe centile fall of >30% (mean MCA-PI 1.94 vs 1.56; p<0.01). Of 43 who labored, operative delivery for suspected intrapartum fetal compromise was required in 12 cases; 9/18 (50%) cases where growth slowed, and 3/25 (12%) where growth trajectory was maintained (p = 0.01). CONCLUSIONS Slowing in growth across the third trimester among fetuses subsequently born AGA was associated with ultrasound and clinical features of placental insufficiency. Such fetuses may represent an under-recognised cohort at increased risk of stillbirth.
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Affiliation(s)
- Nadia Bardien
- Department of Perinatal Medicine, Mercy Hospital for Women, Melbourne, Australia
- La Trobe University, Mercy Hospital for Women, Melbourne, Australia
| | - Clare L. Whitehead
- Department of Perinatal Medicine, Mercy Hospital for Women, Melbourne, Australia
- Translational Obstetrics Group, University of Melbourne, Melbourne, Australia
| | - Stephen Tong
- Department of Perinatal Medicine, Mercy Hospital for Women, Melbourne, Australia
- Translational Obstetrics Group, University of Melbourne, Melbourne, Australia
| | - Antony Ugoni
- School of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| | - Susan McDonald
- La Trobe University, Mercy Hospital for Women, Melbourne, Australia
| | - Susan P. Walker
- Department of Perinatal Medicine, Mercy Hospital for Women, Melbourne, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
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Stott D, Bolten M, Salman M, Paraschiv D, Clark K, Kametas NA. Maternal demographics and hemodynamics for the prediction of fetal growth restriction at booking, in pregnancies at high risk for placental insufficiency. Acta Obstet Gynecol Scand 2016; 95:329-38. [DOI: 10.1111/aogs.12823] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/03/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Daniel Stott
- Division of Women's Health; King's College Hospital; Antenatal Hypertension Clinic; London UK
| | - Mareike Bolten
- Division of Women's Health; King's College Hospital; Antenatal Hypertension Clinic; London UK
| | - Mona Salman
- Division of Women's Health; King's College Hospital; Antenatal Hypertension Clinic; London UK
| | - Daniela Paraschiv
- Division of Women's Health; King's College Hospital; Antenatal Hypertension Clinic; London UK
| | - Katherine Clark
- Division of Women's Health; King's College Hospital; Antenatal Hypertension Clinic; London UK
| | - Nikos A. Kametas
- Division of Women's Health; King's College Hospital; Antenatal Hypertension Clinic; London UK
- Division of Women's Health; King's College Hospital; Harris Birthright Research Centre for Fetal Medicine; London UK
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Triunfo S, Crovetto F, Scazzocchio E, Parra-Saavedra M, Gratacos E, Figueras F. Contingent versus routine third-trimester screening for late fetal growth restriction. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:81-88. [PMID: 26365218 DOI: 10.1002/uog.15740] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/24/2015] [Accepted: 09/02/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate the use of third-trimester ultrasound screening for late fetal growth restriction (FGR) on a contingent basis, according to risk accrued in the second trimester, in an unselected population. METHODS Maternal characteristics, fetal biometry and second-trimester uterine artery (UtA) Doppler were included in logistic regression analysis to estimate risk for late FGR (birth weight < 3(rd) percentile, or 3(rd) -10(th) percentile plus abnormal cerebroplacental ratio or UtA Doppler, with delivery ≥ 34 weeks). Based on the second-trimester risk, strategies for performing contingent third-trimester ultrasound examinations in 10%, 25% or 50% of the cohort were tested against a strategy of routine ultrasound scanning in the entire population at 32 + 0 to 33 + 6 weeks. RESULTS Models were constructed based on 1393 patients and validated in 1303 patients, including 73 (5.2%) and 82 late FGR (6.3%) cases, respectively. At the second-trimester scan, the a-posteriori second-trimester risk (a-posteriori first-trimester risk (baseline a-priori risk and mean arterial blood pressure) combined with second-trimester abdominal circumference and UtA Doppler) yielded an area under the receiver-operating characteristics curve (AUC) of 0.81 (95% CI, 0.74-0.87) (detection rate (DR), 43.1% for a 10% false-positive rate (FPR)). The combination of a-posteriori second-trimester risk plus third-trimester estimated fetal weight (full model) yielded an AUC of 0.92 (95% CI, 0.88-0.96) (DR, 74% for a 10% FPR). Subjecting 10%, 25% or 50% of the study population to third-trimester ultrasound, based on a-posteriori second-trimester risk, gave AUCs of 0.81 (95% CI, 0.75-0.88), 0.84 (95% CI, 0.78-0.91) and 0.89 (95% CI, 0.84-0.94), respectively. Only the 50% contingent model proved statistically equivalent to performing routine third-trimester ultrasound scans (AUC, 0.92 (95% CI, 0.88-0.96), P = 0.11). CONCLUSION A strategy of selecting 50% of the study population to undergo third-trimester ultrasound examination, based on accrued risk in the second trimester, proved equivalent to routine third-trimester ultrasound scanning in predicting late FGR.
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Affiliation(s)
- S Triunfo
- Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Valencia, Spain
| | - F Crovetto
- Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Valencia, Spain
- Fondazione Cà Granda, Ospedale Maggiore Policlinico, Dipartimento Ostetricia e Ginecologia, Università degli Studi di Milano, Milan, Italy
| | - E Scazzocchio
- Obstetrics, Gynecology and Reproductive Medicine Department, Institut Universitari Dexeus, Barcelona, Spain
| | - M Parra-Saavedra
- Maternal-Fetal Unit, CEDIFETAL, Centro de Diagnóstico de Ultrasonido e Imágenes, CEDIUL, Barranquilla, Colombia
| | - E Gratacos
- Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Valencia, Spain
| | - F Figueras
- Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Valencia, Spain
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225
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Monier I, Blondel B, Ego A, Kaminski M, Goffinet F, Zeitlin J. Does the Presence of Risk Factors for Fetal Growth Restriction Increase the Probability of Antenatal Detection? A French National Study. Paediatr Perinat Epidemiol 2016; 30:46-55. [PMID: 26488771 DOI: 10.1111/ppe.12251] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Screening for fetal growth restriction (FGR) is a major component of prenatal care. We investigated whether the presence of maternal and pregnancy risk factors for FGR improves the antenatal suspicion of FGR for infants born small-for-gestational age (SGA) as well as their impact on screening specificity. METHODS Data are from a representative sample of births from the 2010 French National Perinatal Survey (n = 14 100). Detection of FGR was determined by a suspicion of FGR noted in medical charts. Analyses were performed for singleton infants with birthweight under the 10th percentile (SGA), under the 3rd percentile (severely SGA), and above the 10th percentile (false positives) of French references. We studied risk factors for FGR (medical and obstetric conditions, advanced maternal age, nulliparity, body mass index and smoking) using multivariable Poisson regression to derive adjusted risk ratios (aRR). RESULTS Of SGA infants, 21.7% were suspected of FGR. The presence of obstetric and medical risk factors for FGR was associated with higher suspicion among SGA infants [RR 2.1, 95% confidence interval (CI) 1.7, 2.7]. However, despite the presence of these factors, 60% and 40% of SGA and severely SGA infants, respectively, were not suspected of FGR. Two per cent of normal birthweight infants were suspected of FGR, increasing to 5% when obstetric and medical risk factors were present. Smoking and older maternal age were unrelated to suspicion while females were more likely to be suspected of FGR. CONCLUSION Our results suggest that better risk assessment could improve antenatal identification of FGR. Sex-specific fetal growth references should be used to avoid systematic bias linked to sex.
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Affiliation(s)
- Isabelle Monier
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - Béatrice Blondel
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - Anne Ego
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France.,Clinical Research Center (CICO3), Grenoble University Hospital, Grenoble, France
| | - Monique Kaminski
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - François Goffinet
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France.,Port-Royal Maternity Unit, Department of Obstetrics and Gynaecology, Cochin University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Jennifer Zeitlin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
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226
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Krauskopf AL, Knippel AJ, Verde PE, Kozlowski P. Predicting SGA neonates using first-trimester screening: influence of previous pregnancy's birthweight and PAPP-A MoM. J Matern Fetal Neonatal Med 2015; 29:2962-7. [PMID: 26551433 DOI: 10.3109/14767058.2015.1109622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Investigating the proportions of anamnestic and biochemical variables of the previous and current pregnancies for the prediction of small for gestational age (SGA) neonates in the current pregnancy. METHODS In this observational retrospective study, 45 029 pregnancies were examined, including 3862 patients with more than one pregnancy. Odds ratios for SGA using anamnestic parameters and pregnancy-associated plasma protein A (PAPP-A) values from all pregnancies were estimated by using a logistic regression model. RESULTS There were 2552 (5.7%) SGA neonates. Two threshold PAPP-A values were identified at 0.15 MoM and 0.33 MoM with probabilities for SGA of 23% and 17%, respectively. A previous SGA < 10th centile and a current PAPP-A MoM value < 5th centile result in odds ratios of 4.8 (95% CI: 3.5-6.5) and 3.0 (95% CI: 1.8-5.0), respectively. The parameters' combined odds ratio is 14.1 (95% CI: 3.9-50.3) with a number needed to screen of ten for one SGA neonate at a detection rate of 37%. CONCLUSION Information on previous pregnancies affected by SGA and a current pregnancy's low PAPP-A value are reliable predictors for a SGA delivery. First-trimester biochemical analysis should be maintained to detect women at risk for delivering a SGA neonate.
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Affiliation(s)
| | | | - Pablo Emilio Verde
- b Coordination Center for Clinical Trials, University of Düsseldorf , Düsseldorf, NRW , Germany
| | - Peter Kozlowski
- a Praenatal-Medizin Und Genetik Düsseldorf , Düsseldorf, NRW , Germany and
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227
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Pay A, Frøen JF, Staff AC, Jacobsson B, Gjessing HK. Prediction of small-for-gestational-age status by symphysis-fundus height: a registry-based population cohort study. BJOG 2015; 123:1167-73. [PMID: 26644370 DOI: 10.1111/1471-0528.13727] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To develop a chart for risk of small-for-gestational-age (SGA) at birth depending on deviations in symphysis-fundus (SF) height values for gestational age during pregnancy weeks 24-42. DESIGN Registry-based population cohort study. SETTING Antenatal clinics, Västra Götaland County, Sweden, 2005-2010. POPULATION The study included 42 018 women with ultrasound-dated singleton pregnancies who delivered at Sahlgrenska University Hospital. Data (including 282 713 SF height measurements) were extracted from the hospital's computerised obstetric database. METHODS Linear and binary regression analyses were used to derive prediction models with deviations in birthweight (BW) and SF height by gestational age as dependent and independent variables, respectively. Receiver operating characteristic curves were generated to evaluate the predictive value of the model in detecting SGA. MAIN OUTCOME MEASURES Birthweight and small-for-gestational-age. RESULTS Symphysis-fundus height accounted for 3% of individual BW variance at 24 weeks, increasing gradually to 20% at 40 weeks. Maternal factors explained an additional 10 percentage points of BW variance. Receiver operating characteristic curves confirmed that SF height was a stronger SGA predictor in late than in early pregnancy. Using an SGA relative risk cut-off limit of ≥2-fold, the overall sensitivity was 50% and the overall specificity 80%. Only the most recent SF measurement was useful in predicting BW deviation; previous measurements added nothing to the predictive value. CONCLUSIONS The ability of SF measurements to detect SGA status at birth increases with gestational age. Only the most recent SF measurement has predictive value; a static or falling pattern of SF values did not increase SGA likelihood. TWEETABLE ABSTRACT New SF curves predict SGA best in late pregnancy; only the most recent SF measurement has predictive value.
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Affiliation(s)
- Asd Pay
- Departments of Obstetrics and Gynaecology, Women's and Children's Division, Oslo University Hospital, Oslo, Norway.,Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway
| | - J F Frøen
- Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway
| | - A C Staff
- Departments of Obstetrics and Gynaecology, Women's and Children's Division, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - B Jacobsson
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden.,Department of Genes and Environment, Norwegian Institute of Public Health, Oslo, Norway
| | - H K Gjessing
- Department of Genes and Environment, Norwegian Institute of Public Health, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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228
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Sohlberg S, Mulic-Lutvica A, Olovsson M, Weis J, Axelsson O, Wikström J, Wikström AK. Magnetic resonance imaging-estimated placental perfusion in fetal growth assessment. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:700-705. [PMID: 25640054 PMCID: PMC5063104 DOI: 10.1002/uog.14786] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/29/2014] [Accepted: 01/07/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To evaluate in-vivo placental perfusion fraction, estimated by magnetic resonance imaging (MRI), as a marker of placental function. METHODS A study population of 35 pregnant women, of whom 13 had pre-eclampsia (PE), were examined at 22-40 weeks' gestation. Within a 24-h period, each woman underwent an MRI diffusion-weighted sequence (from which we calculated the placental perfusion fraction), venous blood sampling and an ultrasound examination including estimation of fetal weight, amniotic fluid index and Doppler velocity measurements. The perfusion fractions in pregnancies with and without fetal growth restriction were compared and correlations between the perfusion fraction and ultrasound estimates and plasma markers were estimated using linear regression. The associations between the placental perfusion fraction and ultrasound estimates were modified by the presence of PE (P < 0.05) and therefore we included an interaction term between PE and covariates in the models. RESULTS The median placental perfusion fractions in pregnancies with and without fetal growth restriction were 21% and 32%, respectively (P = 0.005). The correlations between placental perfusion fraction and ultrasound estimates and plasma markers were highly significant (P = 0.002 and P = 0.0001, respectively). The highest coefficient of determination (R(2) = 0.56) for placental perfusion fraction was found for a model that included pulsatility index in the ductus venosus, plasma level of soluble fms-like tyrosine kinase-1, estimated fetal weight and presence of PE. CONCLUSION The placental perfusion fraction has the potential to contribute to the clinical assessment of cases with placental insufficiency.
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Affiliation(s)
- S Sohlberg
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - A Mulic-Lutvica
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - M Olovsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - J Weis
- Department of Surgical Sciences, Section of Radiology, Uppsala University, Uppsala, Sweden
| | - O Axelsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
| | - J Wikström
- Department of Surgical Sciences, Section of Radiology, Uppsala University, Uppsala, Sweden
| | - A-K Wikström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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229
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Familiari A, Bhide A, Morlando M, Scala C, Khalil A, Thilaganathan B. Mid-pregnancy fetal biometry, uterine artery Doppler indices and maternal demographic characteristics: role in prediction of small-for-gestational-age birth. Acta Obstet Gynecol Scand 2015; 95:238-44. [PMID: 26472057 DOI: 10.1111/aogs.12804] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 10/09/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the role of mid-trimester fetal biometry, uterine artery Doppler indices and maternal demographics in prediction of small-for-gestational-age (SGA) birth. MATERIALS AND METHODS We conducted a retrospective cohort study in a single referral center. The study included 23 894 singleton pregnancies scanned between 19 and 24 weeks of gestation. Maternal demographics included age, body mass index and ethnicity. Fetal biometry, birthweight and uterine artery pulsatility index values were converted into centiles. Multivariable logistic regression analysis was performed and the predictive accuracy was assessed using receiver operating characteristic curve analysis. The main outcome measure was prediction of delivery of preterm and term SGA neonates defined as a birthweight in the lowest centile groups (<10th, <5th and <3rd centiles). RESULTS Maternal ethnicity, fetal biometry and uterine artery Doppler indices were significantly associated with the risk of SGA <5th centile (p < 0.01). Maternal factors or fetal biometry alone showed poor to moderate performance in prediction of term and preterm SGA <5th centile at a 10% false-positive rate. Uterine artery pulsatility index alone was able to predict 25, 60 and 77% of SGA <5th centile delivering at >37, <37 and <32 weeks of gestation respectively at a 10% false-positive rate; maternal factors, fetal biometry and uterine artery Doppler combined detected 40, 66 and 89% of term, preterm and very preterm SGA <5th centile at a 10% false-positive rate. CONCLUSIONS Second-trimester screening can identify the majority of pregnancies at high risk of SGA birth and showed a higher performance for earlier gestational ages at birth and lower birthweight centiles.
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Affiliation(s)
- Alessandra Familiari
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's University of London, London, UK
| | - Amar Bhide
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's University of London, London, UK
| | - Maddalena Morlando
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's University of London, London, UK
| | - Carolina Scala
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's University of London, London, UK
| | - Asma Khalil
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's University of London, London, UK
| | - Basky Thilaganathan
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's University of London, London, UK
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230
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Bakalis S, Peeva G, Gonzalez R, Poon LC, Nicolaides KH. Prediction of small-for-gestational-age neonates: screening by biophysical and biochemical markers at 30-34 weeks. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:446-451. [PMID: 25826154 DOI: 10.1002/uog.14863] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 03/25/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the potential value of combined screening by maternal characteristics and medical history (maternal factors), estimated fetal weight (EFW), uterine artery pulsatility index (UtA-PI), mean arterial pressure (MAP) and serum levels of placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) at 30-34 weeks' gestation in the prediction of delivery of small-for-gestational-age (SGA) neonates, in the absence of pre-eclampsia (PE). METHODS This was a screening study in 9472 singleton pregnancies at 30-34 weeks' gestation, comprising 469 that delivered SGA neonates and 9003 cases unaffected by SGA, PE or gestational hypertension. Multivariable logistic regression analysis was used to determine if UtA-PI, MAP and serum PlGF or sFlt-1, individually or in combination, improved the prediction of SGA neonates provided from screening by maternal factors and EFW. RESULTS Compared to the normal group, mean log10 multiples of the median (MoM) values of UtA-PI, MAP and serum sFlt-1 were significantly higher and log10 MoM PlGF was lower in the SGA group. Multivariable logistic regression analysis demonstrated that in the prediction of SGA neonates with a birth weight < 5(th) percentile, delivering < 5 weeks and ≥ 5 weeks after assessment, there were significant independent contributions from maternal factors, EFW, UtA-PI, MAP, and serum PlGF and sFlt-1, but the best performance was provided by a combination of maternal factors, EFW, UtA-PI, MAP and serum PlGF, excluding sFlt-1. Combined screening predicted, at a 10% false-positive rate, 89%, 94%, 96% of SGA neonates delivering at 32-36 weeks' gestation with birth weight < 10(th) , < 5(th) and < 3(rd) percentiles, respectively; the respective detection rates of combined screening for SGA neonates delivering ≥ 37 weeks were 57%, 65% and 72%. CONCLUSION Combined screening by maternal factors and biophysical and biochemical markers at 30-34 weeks' gestation could identify a high proportion of pregnancies that will deliver SGA neonates.
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Affiliation(s)
- S Bakalis
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - G Peeva
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - R Gonzalez
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - L C Poon
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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231
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Triunfo S, Parra-Saavedra M, Rodriguez-Sureda V, Crovetto F, Dominguez C, Gratacós E, Figueras F. Angiogenic Factors and Doppler Evaluation in Normally Growing Fetuses at Routine Third-Trimester Scan: Prediction of Subsequent Low Birth Weight. Fetal Diagn Ther 2015; 40:13-20. [DOI: 10.1159/000440650] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 08/25/2015] [Indexed: 11/19/2022]
Abstract
Objective: To evaluate in normally growing fetuses at routine 32-36 weeks scan the performance of maternal angiogenic factors, Doppler and ultrasound indices in predicting smallness for gestational age (SGA) at birth. Methods: A cohort of 1,000 singleton pregnancies with normal estimated fetal weight (EFW, ≥10th centile) at 32-36 weeks scan was included. At inclusion, Doppler indices (mean uterine artery pulsatility index [mUtA-PI], cerebroplacental ratio and normalized umbilical vein blood flow by EFW (ml/min/kg) were evaluated, and blood samples were collected and frozen. Nested in this cohort, maternal circulating placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) were assayed by enzyme-linked immunosorbent assay in all cases with a birth weight <10th centile by customized standards and in an equivalent number of controls (birth weight ≥10th centile). Results: 160 cases were included (80 SGA and 80 controls). EFW (2,128 vs. 2,279 g, p < 0.001), mUtA-PI z-values (-0.25 vs. -0.65, p = 0.034) and sFlt-1/PlGF ratio (11.10 vs. 6.74, p < 0.005) were lower in SGA. The combination of sFlt-1/PlGF ratio and EFW resulted in a 66.3% detection rate for subsequent SGA, with 20% of false-positives. Fetal Doppler indices were not predictive of SGA. Conclusions: In normally growing fetuses, maternal angiogenic factors add to ultrasound parameters in predicting subsequent SGA at birth. This supports further research to investigate composite scores in order to improve the definition and identification of fetal growth restriction.
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232
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Poon LC, Lesmes C, Gallo DM, Akolekar R, Nicolaides KH. Prediction of small-for-gestational-age neonates: screening by biophysical and biochemical markers at 19-24 weeks. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:437-445. [PMID: 25988293 DOI: 10.1002/uog.14904] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 05/08/2015] [Accepted: 05/12/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the value of combined screening by maternal characteristics and medical history, fetal biometry and biophysical and biochemical markers at 19-24 weeks' gestation, for prediction of delivery of small-for-gestational-age (SGA) neonates, in the absence of pre-eclampsia (PE), and examine the potential value of such assessment in deciding whether the third-trimester scan should be at 32 and/or 36 weeks' gestation. METHODS This was a screening study in 7816 singleton pregnancies, including 389 (5.0%) that delivered SGA neonates with birth weight < 5(th) percentile (SGA < 5(th) ), in the absence of PE. Multivariable logistic regression analysis was used to determine if screening by a combination of maternal factors, fetal biometry, uterine artery pulsatility index (UtA-PI) and maternal serum concentrations of placental growth factor (PlGF) and α-fetoprotein (AFP) had significant contribution in predicting SGA neonates. A model was developed for selecting the gestational age for third-trimester assessment, at 32 and/or 36 weeks, based on the results of screening at 19-24 weeks. RESULTS Significant independent contributions to the prediction of SGA < 5(th) were provided by maternal factors, fetal biometry, UtA-PI and serum PlGF and AFP. The detection rate (DR) of such combined screening at 19-24 weeks was 100%, 78% and 42% for SGA < 5(th) delivering < 32, at 32-36 and ≥ 37 weeks' gestation, respectively, at a false-positive rate (FPR) of 10%. In a hypothetical model, it was estimated that if the desired objective of prenatal screening is to predict about 80% of the cases of SGA < 5(th) , it would be necessary to select 11% of the population at the 19-24-week assessment to be reassessed at 32 weeks and 44% to be reassessed at 36 weeks; 57% would not require a third-trimester scan. CONCLUSION Prenatal prediction of a high proportion of SGA neonates necessitates the undertaking of screening in the third trimester of pregnancy, in addition to assessment in the second trimester, and the timing of such screening, at 32 and/or 36 weeks, should be contingent on the results of the assessment at 19-24 weeks.
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Affiliation(s)
- L C Poon
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - C Lesmes
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - D M Gallo
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - R Akolekar
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
- Fetal Medicine Unit, Medway Maritime Hospital, Gillingham, Kent, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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233
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Roma E, Arnau A, Berdala R, Bergos C, Montesinos J, Figueras F. Ultrasound screening for fetal growth restriction at 36 vs 32 weeks' gestation: a randomized trial (ROUTE). ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:391-397. [PMID: 26031399 DOI: 10.1002/uog.14915] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 05/18/2015] [Accepted: 05/26/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To compare the utility of routine third-trimester ultrasound examination at 36 weeks' gestation with that at 32 weeks in detecting fetal growth restriction (FGR). METHODS This was an open-label parallel randomized trial (ROUTE study) conducted at a single general hospital serving a geographically well-defined catchment area in Barcelona, Spain, between May 2011 and April 2014. Women with no adverse medical or obstetric history and a singleton pregnancy without fetal abnormalities at routine second-trimester scan were assigned randomly to undergo a scan at 32 weeks' gestation (n = 1272) or at 36 weeks' gestation (n = 1314). Primary outcome measures were detection rates of FGR (customized birth weight < 10(th) centile) and severe FGR (customized birth weight < 3(rd) centile). RESULTS There were no significant differences in perinatal outcome between those who underwent a scan at 32 weeks' gestation and those who underwent a scan at 36 weeks' gestation. Severe FGR at birth was associated significantly with emergency Cesarean delivery for fetal distress (odds ratio (OR), 3.4 (95% CI, 1.8-6.7)), neonatal admission (OR, 2.23 (95% CI, 1.23-4.05)), hypoglycemia (OR, 9.5 (95% CI, 1.8-49.8)) and hyperbilirubinemia (OR, 9.0 (95% CI, 4.6-17.6)). Despite similar false-positive rates (FPRs) (6.4% vs 8.2%), FGR detection rates were superior at 36 vs 32 weeks' gestation (sensitivity, 38.8% vs 22.5%; P = 0.006), with positive and negative likelihood ratios of 6.1 vs 2.7 and 0.65 vs 0.84, respectively. In cases of severe FGR, FPRs for both scans were also similar (8.5% vs 8.7%), but detection rates were superior at 36 vs 32 weeks' gestation (61.4% vs 32.5%; P = 0.008). Positive and negative likelihood ratios were 7.2 vs 3.7 and 0.4 vs 0.74, respectively. CONCLUSION In low-risk pregnancies, routine ultrasound examination at 36 weeks' gestation was more effective than that at 32 weeks' gestation in detecting FGR and related adverse perinatal and neonatal outcomes.
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Affiliation(s)
- E Roma
- Obstetrics and Gynecology Department, Althaia, Network Healthcare Manresa Foundation, Barcelona, Spain
| | - A Arnau
- Research and Innovation Unit, Althaia, Network Healthcare Manresa Foundation, Barcelona, Spain
| | - R Berdala
- Obstetrics and Gynecology Department, Althaia, Network Healthcare Manresa Foundation, Barcelona, Spain
| | - C Bergos
- Obstetrics and Gynecology Department, Althaia, Network Healthcare Manresa Foundation, Barcelona, Spain
| | - J Montesinos
- Research and Innovation Unit, Althaia, Network Healthcare Manresa Foundation, Barcelona, Spain
| | - F Figueras
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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Lesmes C, Gallo DM, Saiid Y, Poon LC, Nicolaides KH. Prediction of small-for-gestational-age neonates: screening by uterine artery Doppler and mean arterial pressure at 19-24 weeks. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:332-340. [PMID: 25810352 DOI: 10.1002/uog.14855] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/17/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the potential value of uterine artery (UtA) pulsatility index (PI) and mean arterial pressure (MAP) at 19-24 weeks' gestation, in combination with maternal characteristics and medical history and fetal biometry in the prediction of delivery of small-for-gestational-age (SGA) neonates in the absence of pre-eclampsia (PE) and to examine the potential value of such assessment in deciding whether the third-trimester scan should be performed at 32 and/or 36 weeks' gestation. METHODS This was a screening study in 63 975 singleton pregnancies, including 3702 (5.8%) that delivered SGA neonates with birth weight < 5(th) percentile (SGA < 5(th) ) in the absence of PE. Multivariable logistic regression analysis was used to determine if screening by a combination of maternal factors, fetal head circumference (HC), abdominal circumference (AC), femur length (FL), UtA-PI and MAP had significant contribution in predicting SGA neonates. A model was developed to select gestational age for the third-trimester assessment, at 32 and/or 36 weeks, based on the results of screening at 19-24 weeks. RESULTS The detection rates (DRs) of combined screening by maternal factors, fetal biometry and UtA-PI at 19-24 weeks were 90%, 68% and 44% for SGA < 5(th) delivering < 32, 32-36 and ≥ 37 weeks' gestation, respectively, at a false-positive rate (FPR) of 10%. The performance of screening was not improved by the addition of MAP. The DR of SGA < 5(th) delivering at 32-36 weeks improved from 68% to 90% with screening at 32 rather than at 19-24 weeks. Similarly, the DR of SGA < 5(th) delivering ≥ 37 weeks improved from 44% with screening at 19-24 weeks to 59% and 76% when screening at 32 and 36 weeks, respectively. In a hypothetical model, it was estimated that if the desired objective of prenatal screening is to predict about 80% of the cases of SGA < 5(th) , it would be necessary to select 17% of the population at the 19-24-week assessment to be reassessed at 32 weeks and 38% to be reassessed at 36 weeks; 62% would not require a third-trimester scan. CONCLUSION Prenatal prediction of a high proportion of SGA neonates necessitates the undertaking of screening in the third trimester of pregnancy in addition to assessment in the second trimester, and the timing of such screening, at 32 and/or 36 weeks, should be contingent on the results of the assessment at 19-24 weeks.
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Affiliation(s)
- C Lesmes
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - D M Gallo
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - Y Saiid
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - L C Poon
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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Lesmes C, Gallo DM, Gonzalez R, Poon LC, Nicolaides KH. Prediction of small-for-gestational-age neonates: screening by maternal serum biochemical markers at 19-24 weeks. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:341-349. [PMID: 25969963 DOI: 10.1002/uog.14899] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 05/05/2015] [Accepted: 05/07/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the value of maternal serum concentrations of placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1), pregnancy-associated plasma protein-A (PAPP-A), free β-human chorionic gonadotropin (β-hCG) and α-fetoprotein (AFP) at 19-24 weeks' gestation, in combination with maternal factors and fetal biometry, in the prediction of delivery of small-for-gestational-age (SGA) neonates, in the absence of pre-eclampsia (PE) and examine the potential value of such assessment in deciding whether the third-trimester scan should be performed at 32 and/or 36 weeks' gestation. METHODS This was a screening study in 9715 singleton pregnancies, including 481 (5.0%) that delivered SGA neonates with birth weight < 5(th) percentile (SGA < 5(th) ), in the absence of PE. Multivariable logistic regression analysis was used to determine if screening by a combination of maternal factors, Z-scores of fetal head circumference, abdominal circumference and femur length, and log10 multiples of the median (MoM) values of PlGF, sFlt-1, PAPP-A, free β-hCG or AFP had a significant contribution to the prediction of SGA neonates. A model was developed in selecting the gestational age for third-trimester assessment, at 32 and/or 36 weeks, based on the results of screening at 19-24 weeks. RESULTS Compared to the normal group, the mean log10 MoM value of PlGF was lower, AFP was higher and sFlt-1, PAPP-A and free β-hCG were not significantly different in the SGA < 5(th) group that delivered < 37 weeks. The detection rate (DR) of combined screening by maternal factors, fetal biometry and serum PlGF and AFP at 19-24 weeks was 100%, 76% and 38% for SGA < 5(th) delivering < 32, 32-36 and ≥ 37 weeks' gestation, respectively, at a false-positive rate (FPR) of 10%. In a hypothetical model, it was estimated that, if the desired objective of prenatal screening is to predict about 80% of the cases of SGA < 5(th) , it would be necessary to select 11% of the population at the 19-24-week assessment to be reassessed at 32 weeks and 46% to be reassessed at 36 weeks; 54% would not require a third-trimester scan. CONCLUSION Prenatal prediction of a high proportion of SGA neonates necessitates the undertaking of screening in the third trimester of pregnancy, in addition to assessment in the second trimester, and the timing of such screening, at 32 and/or 36 weeks, should be contingent on the results of the assessment at 19-24 weeks.
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Affiliation(s)
- C Lesmes
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - D M Gallo
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - R Gonzalez
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - L C Poon
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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Bakalis S, Gallo DM, Mendez O, Poon LC, Nicolaides KH. Prediction of small-for-gestational-age neonates: screening by maternal biochemical markers at 30-34 weeks. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:208-215. [PMID: 25826797 DOI: 10.1002/uog.14861] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 03/25/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the potential value of serum placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1), pregnancy-associated plasma protein-A (PAPP-A), free β-human chorionic gonadotropin (β-hCG) and α-fetoprotein (AFP) at 30-34 weeks' gestation in the prediction of delivery of small-for-gestational-age (SGA) neonates, in the absence of pre-eclampsia (PE). METHODS This was a screening study in singleton pregnancies at 30-34 weeks' gestation, including 490 that delivered SGA neonates and 9360 cases that were unaffected by SGA, PE or gestational hypertension (normal outcome). Multivariable logistic regression analysis was used to determine if screening by serum PlGF, sFlt-1, PAPP-A, free β-hCG and AFP, individually or in combination, improved the prediction of SGA neonates provided by screening with maternal characteristics and medical history (maternal factors), and estimated fetal weight (EFW) from fetal head circumference, abdominal circumference and femur length. RESULTS Compared to the normal group, the mean log10 multiples of the median (MoM) values of PlGF and AFP were significantly lower and the mean log10 MoM values of sFlt-1 and free β-hCG were significantly higher in the SGA group with a birth weight < 5(th) percentile (SGA < 5(th)) delivering < 5 weeks following assessment. The best model for prediction of SGA was provided by a combination of maternal factors, EFW and serum PlGF. Such combined screening, predicted, at a 10% false-positive rate, 85%, 93% and 92% of SGA neonates delivering < 5 weeks following assessment with birth weight < 10(th), < 5(th) and < 3(rd) percentiles, respectively; the respective detection rates of combined screening for SGA neonates delivering ≥ 5 weeks following assessment were 57%, 64% and 71%. CONCLUSION Combined screening by maternal factors, EFW and serum PlGF at 30-34 weeks' gestation can identify a high proportion of pregnancies that subsequently deliver SGA neonates.
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Affiliation(s)
- S Bakalis
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - D M Gallo
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - O Mendez
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - L C Poon
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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Lesmes C, Gallo DM, Panaiotova J, Poon LC, Nicolaides KH. Prediction of small-for-gestational-age neonates: screening by fetal biometry at 19-24 weeks. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:198-207. [PMID: 25704207 DOI: 10.1002/uog.14826] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 02/03/2015] [Accepted: 02/04/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the value of fetal biometry at 19-24 weeks' gestation in the prediction of delivery of small-for-gestational-age (SGA) neonates, in the absence of pre-eclampsia (PE), and examine the potential value of such assessment in deciding whether the third-trimester scan should be at 32 and/or 36 weeks' gestation. METHODS This was a screening study in 88,187 singleton pregnancies, including 5003 (5.7%) that delivered SGA neonates with birth weight < 5(th) percentile (SGA < 5(th)). Multivariable logistic regression analysis was used to determine if screening by a combination of maternal characteristics and medical history and Z-scores of fetal head circumference (HC), abdominal circumference (AC) and femur length (FL) had significant contribution in predicting SGA neonates. A model was developed for selecting the gestational age for third-trimester assessment, at 32 and/or 36 weeks, based on the results of screening at 19-24 weeks. RESULTS Combined screening by maternal factors and fetal biometry at 19-24 weeks, predicted 76%, 58% and 44% of SGA < 5(th) delivering < 32, 32-36 and ≥ 37 weeks' gestation, respectively, at a false-positive rate (FPR) of 10%. The detection rate (DR) of SGA < 5(th) delivering at 32-36 weeks improved from 58% to 82% with screening at 32 weeks rather than at 19-24 weeks. Similarly, the DR of SGA < 5(th) delivering ≥ 37 weeks improved from 44% with screening at 19-24 weeks to 61% and 76% with screening at 32 and 36 weeks, respectively. In a hypothetical model, it was estimated that if the desired objective of prenatal screening is to predict about 80% of the cases of SGA < 5(th), it would be necessary to select 28% of the population at the 19-24-week assessment to be reassessed at 32 weeks and 41% to be reassessed at 36 weeks; in 59% of pregnancies there would be no need for a third-trimester scan. CONCLUSION Prenatal prediction of a high proportion of SGA neonates necessitates the undertaking of screening in the third trimester of pregnancy, in addition to assessment in the second trimester, and the timing of such screening, either at 32 and/or 36 weeks, should be contingent on the results of the assessment at 19-24 weeks.
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Affiliation(s)
- C Lesmes
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - D M Gallo
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - J Panaiotova
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - L C Poon
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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Fadigas C, Peeva G, Mendez O, Poon LC, Nicolaides KH. Prediction of small-for-gestational-age neonates: screening by placental growth factor and soluble fms-like tyrosine kinase-1 at 35-37 weeks. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:191-197. [PMID: 25825848 DOI: 10.1002/uog.14862] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 03/25/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the potential value of maternal serum placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) at 35-37 weeks' gestation in the prediction of delivery of small-for-gestational-age (SGA) neonates, in the absence of pre-eclampsia (PE). METHODS This was a screening study in singleton pregnancies at 35-37 weeks, including 158 that delivered SGA neonates with birth weight < 5(th) percentile and 3701 cases unaffected by SGA, PE or gestational hypertension. Multivariable logistic regression analysis was used to determine if measuring serum levels of PlGF and sFlt-1 improved the prediction of delivery of SGA neonates provided by screening with maternal characteristics and medical history (maternal factors), and estimated fetal weight (EFW) from fetal head circumference, abdominal circumference and femur length. RESULTS Compared to the normal group, the median PlGF multiples of the median (MoM) was significantly lower and the median sFlt-1 MoM was significantly higher in the SGA group. Combined screening by maternal factors and EFW at 35-37 weeks predicted, at 10% false-positive rate (FPR), 90%, 92% and 94% of SGA neonates with birth weight < 10(th), < 5(th) and < 3(rd) percentiles, respectively, delivering < 2 weeks following assessment; the respective values for SGA delivering ≥ 37 weeks were 66%, 73% and 80%. When PlGF and sFlt-1 were added to a model that combines maternal factors and EFW, sFlt-1 did not remain as a significant independent predictor of SGA < 5(th). Combined screening by maternal factors, EFW and serum PlGF, predicted, at a 10% FPR, 88%, 96% and 94% of SGA neonates with birth weight < 10(th), < 5(th) and < 3(rd) percentiles, respectively, delivering < 2 weeks following assessment and the respective values for SGA delivering ≥ 37 weeks were 64%, 75% and 80%. CONCLUSION sFlt-1 does not provide significant independent prediction of SGA, in the absence of PE, in addition to combined testing by maternal factors and fetal biometry at 35-37 weeks; whilst the addition of PlGF alone marginally improves the performance of screening.
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Affiliation(s)
- C Fadigas
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - G Peeva
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - O Mendez
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - L C Poon
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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Callec R, Lamy C, Perdriolle-Galet E, Patte C, Heude B, Morel O. Impact on obstetric outcome of third-trimester screening for small-for-gestational-age fetuses. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:216-220. [PMID: 25487165 DOI: 10.1002/uog.14755] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 11/26/2014] [Accepted: 12/04/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To evaluate the performance of screening for small-for-gestational-age (SGA) fetuses by ultrasound biometry at 30-35 weeks' gestation, and to determine the impact of screening on obstetric and neonatal outcomes. METHODS For this prospective cohort study, pregnant women were recruited from two French university maternity centers between 2003 and 2006. Performance measures of third-trimester biometry for the prediction of SGA, defined as estimated fetal weight < 10(th) centile, were analyzed. Obstetric outcomes and neonatal health status were compared, first, between SGA neonates diagnosed correctly at ultrasound examination (true positive (TP); n = 45) and SGA neonates that went undiagnosed (false negative (FN); n = 110) and, second, between non-SGA neonates identified as normal at ultrasound examination (true negative (TN); n = 1641) and non-SGA neonates diagnosed incorrectly as SGA (false positive (FP); n = 101). RESULTS In the prediction of SGA, third-trimester ultrasound had a sensitivity of 29.0% (95% CI, 22.5-36.6%) and specificity of 94.2% (95% CI, 93.0-95.2%). Positive and negative predictive values were 30.8% (95% CI, 23.9-38.7%) and 93.7% (95% CI, 92.5-94.8%), respectively. One hundred and ten SGA neonates went undiagnosed at ultrasound. Compared to the TN neonates considered as of normal weight at ultrasound, planned preterm delivery (before 37 weeks) and elective Cesarean section for a fetal growth indication were 2.4 (P = 0.01) and 2.85 (P = 0.003) times more likely to occur, respectively, in the FP group of non-SGA neonates, diagnosed incorrectly as SGA during the antenatal period. There was no statistically significant difference in 5-min Apgar score < 7, cord blood pH at birth < 7.15 and need for neonatal resuscitation between the two subgroups (TN vs FP and TP vs FN). CONCLUSIONS The performance of third-trimester ultrasound screening for SGA seems poor, as it misses the diagnosis of a large number of SGA neonates. The consequences of routine screening for SGA in a low-risk population may lead to unnecessary planned preterm deliveries and elective Cesarean sections in FP pregnancies, without improved neonatal outcome in the FN pregnancies.
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Affiliation(s)
- R Callec
- Obstetrics and Fetal Medicine Unit, Centre Hospitalier Universitaire, Nancy, France
- Université de Lorraine, Nancy, France
- INSERM, U947, Nancy, France
| | - C Lamy
- Obstetrics and Fetal Medicine Unit, Centre Hospitalier Universitaire, Nancy, France
| | - E Perdriolle-Galet
- Obstetrics and Fetal Medicine Unit, Centre Hospitalier Universitaire, Nancy, France
- Université de Lorraine, Nancy, France
- INSERM, U947, Nancy, France
| | - C Patte
- Obstetrics and Fetal Medicine Unit, Centre Hospitalier Universitaire, Nancy, France
| | - B Heude
- Centre for Research in Epidemiology and Population Health (CESP), INSERM, Villejuif, France
- Université Paris Sud, Villejuif, France
| | - O Morel
- Obstetrics and Fetal Medicine Unit, Centre Hospitalier Universitaire, Nancy, France
- Université de Lorraine, Nancy, France
- INSERM, U947, Nancy, France
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Abstract
BACKGROUND Diagnostic ultrasound is used selectively in late pregnancy where there are specific clinical indications. However, the value of routine late pregnancy ultrasound screening in unselected populations is controversial. The rationale for such screening would be the detection of clinical conditions which place the fetus or mother at high risk, which would not necessarily have been detected by other means such as clinical examination, and for which subsequent management would improve perinatal outcome. OBJECTIVES To assess the effects on obstetric practice and pregnancy outcome of routine late pregnancy ultrasound, defined as greater than 24 weeks' gestation, in women with either unselected or low-risk pregnancies. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2015) and reference lists of retrieved studies. SELECTION CRITERIA All acceptably controlled trials of routine ultrasound in late pregnancy (defined as after 24 weeks). DATA COLLECTION AND ANALYSIS Three review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. MAIN RESULTS Thirteen trials recruiting 34,980 women were included in the systematic review. Risk of bias was low for allocation concealment and selective reporting, unclear for random sequence generation and incomplete outcome data and high for blinding of both outcome assessment and participants and personnel. There was no difference in antenatal, obstetric and neonatal outcome or morbidity in screened versus control groups. Routine late pregnancy ultrasound was not associated with improvements in overall perinatal mortality. There is little information on long-term substantive outcomes such as neurodevelopment. There is a lack of data on maternal psychological effects.Overall, the evidence for the primary outcomes of perinatal mortality, preterm birth less than 37 weeks, induction of labour and caesarean section were assessed to be of moderate or high quality with GRADE software. There was no association between ultrasound in late pregnancy and perinatal mortality (risk ratio (RR) 1.01, 95% confidence interval (CI) 0.67 to 1.54; participants = 30,675; studies = eight; I² = 29%), preterm birth less than 37 weeks (RR 0.96, 95% CI 0.85 to 1.08; participants = 17,151; studies = two; I² = 0%), induction of labour (RR 0.93, 95% CI 0.81 to 1.07; participants = 22,663; studies = six; I² = 78%), or caesarean section (RR 1.03, 95% CI 0.92 to 1.15; participants = 27,461; studies = six; I² = 54%). Three additional primary outcomes chosen for the 'Summary of findings' table were preterm birth less than 34 weeks, maternal psychological effects and neurodevelopment at age two. Because none of the included studies reported these outcomes, they were not assessed for quality with GRADE software. AUTHORS' CONCLUSIONS Based on existing evidence, routine late pregnancy ultrasound in low-risk or unselected populations does not confer benefit on mother or baby. There was no difference in the primary outcomes of perinatal mortality, preterm birth less than 37 weeks, caesarean section rates, and induction of labour rates if ultrasound in late pregnancy was performed routinely versus not performed routinely. Meanwhile, data were lacking for the other primary outcomes: preterm birth less than 34 weeks, maternal psychological effects, and neurodevelopment at age two, reflecting a paucity of research covering these outcomes. These outcomes may warrant future research.
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Affiliation(s)
| | - Nancy Medley
- The University of LiverpoolCochrane Pregnancy and Childbirth Group, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
| | - Jeremy J Pratt
- Bunbury Regional HospitalRobertson DriveBunburyAustraliaWA 6230
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Mailath-Pokorny M, Polterauer S, Worda K, Springer S, Bettelheim D. Isolated Short Fetal Femur Length in the Second Trimester and the Association with Adverse Perinatal Outcome: Experiences from a Tertiary Referral Center. PLoS One 2015; 10:e0128820. [PMID: 26046665 PMCID: PMC4457828 DOI: 10.1371/journal.pone.0128820] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 04/30/2015] [Indexed: 11/18/2022] Open
Abstract
Objective To determine the association between isolated mid-trimester short fetal femur length and adverse perinatal outcome. Methods This is a retrospective cohort study of patients with singleton gestations routinely assessed by second trimester ultrasound examination during 2006-2013. A fetal isolated short femur was defined as a femur length (FL) below the 5th percentile in a fetus with an abdominal circumference greater than the 10th percentile. Cases of aneuploidy, skeletal dysplasia and major anomalies were excluded. Primary outcomes of interest included the risk of small for gestational age neonates, low birth weight and preterm birth (PTB). Secondary outcome parameters were a 5-min Apgar score less than 7 and a neonatal intensive care unit admission. A control group of 200 fetuses with FL ≥ 5th percentile was used to compare primary and secondary outcome parameters within both groups. Chi-square and Student’s t-tests were used where appropriate. Results Out of 608 eligible patients with a short FL, 117 met the inclusion criteria. Isolated short FL was associated with an increased risk for small for gestational age (19.7% versus 8.0%, p = 0.002) neonates, low birth weight (23.9% versus 8.5%, p<0.001), PTB (19.7% versus 6.0%, p<0.001) and neonatal intensive care unit admissions (13.7% versus 3.5%, p = 0.001). The incidence of a 5-min Apgar score less than 7 was similar in both groups. Conclusion Isolated short FL is associated with a subsequent delivery of small for gestational age and Low birth weight neonates as well as an increased risk for PTB. This information should be considered when counseling patients after mid-trimester isolated short FL is diagnosed.
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Affiliation(s)
- Mariella Mailath-Pokorny
- Department of Obstetrics and Gynecology, Division of Obstetrics and fetomaternal Medicine, Medical University of Vienna, Vienna, Austria
- * E-mail:
| | - Stephan Polterauer
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Comprehensive Cancer Center, Gynecologic Cancer Unit, Medical University of Vienna, Vienna, Austria
- Karl Landsteiner Institute for General Gynecology and Experimental Gynecologic Oncology, Vienna, Austria
| | - Katharina Worda
- Department of Obstetrics and Gynecology, Division of Obstetrics and fetomaternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Stephanie Springer
- Department of Obstetrics and Gynecology, Division of Obstetrics and fetomaternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Dieter Bettelheim
- Department of Obstetrics and Gynecology, Division of Obstetrics and fetomaternal Medicine, Medical University of Vienna, Vienna, Austria
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Bakalis S, Stoilov B, Akolekar R, Poon LC, Nicolaides KH. Prediction of small-for-gestational-age neonates: screening by uterine artery Doppler and mean arterial pressure at 30-34 weeks. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:707-714. [PMID: 25585604 DOI: 10.1002/uog.14777] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 12/29/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the potential value of uterine artery (UtA) pulsatility index (PI) and mean arterial pressure (MAP) at 30-34 weeks' gestation in the prediction of small-for-gestational-age (SGA) neonates, in the absence of pre-eclampsia (PE). METHODS This was a screening study in singleton pregnancies at 30-34 weeks' gestation, including 1727 that delivered SGA neonates with a birth weight < 5(th) percentile and 29 122 that were unaffected by SGA, PE or gestational hypertension (normal group). Multivariable logistic regression analysis was used to determine if measuring the UtA-PI and MAP improved the prediction of SGA neonates provided by screening with maternal characteristics and medical history (maternal factors), and estimated fetal weight (EFW) calculated from fetal head circumference, abdominal circumference and femur length. RESULTS Combined screening by maternal factors and EFW Z-scores predicted 79%, 87% and 92% of SGA neonates delivering < 5 weeks following assessment, with a birth weight < 10(th) , < 5(th) and < 3(rd) percentiles, respectively, at a false-positive rate of 10%. The addition of UtA-PI and MAP improved the respective detection rates to 83%, 91% and 93%. Screening by maternal factors and EFW Z-scores predicted 53%, 58% and 61% of SGA delivering ≥ 5 weeks following assessment and these rates increased to 53%, 60% and 63% with the addition of UtA-PI and MAP. CONCLUSION Combined testing by maternal factors, fetal biometry, UtA-PI and MAP at 30-34 weeks' gestation could identify a high proportion of pregnancies that deliver SGA neonates.
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Affiliation(s)
- S Bakalis
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - B Stoilov
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - R Akolekar
- Department of Fetal Medicine, Medway Maritime Hospital, Kent, UK
| | - L C Poon
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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243
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Fadigas C, Guerra L, Garcia-Tizon Larroca S, Poon LC, Nicolaides KH. Prediction of small-for-gestational-age neonates: screening by uterine artery Doppler and mean arterial pressure at 35-37 weeks. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:715-721. [PMID: 25780898 DOI: 10.1002/uog.14847] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 03/09/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the potential value of uterine artery (UtA) pulsatility index (PI) and mean arterial pressure (MAP) at 35-37 weeks' gestation in the prediction of delivery of small-for-gestational-age (SGA) neonates, in the absence of pre-eclampsia (PE). METHODS This was a screening study in singleton pregnancies at 35-37 weeks, including 245 that delivered SGA neonates with birth weight < 5(th) percentile and 4876 cases unaffected by SGA, PE or gestational hypertension. Multivariable logistic regression analysis was used to determine if UtA-PI and MAP improved the prediction of SGA neonates provided by screening with maternal characteristics and medical history (maternal factors), and estimated fetal weight (EFW) from fetal head circumference, abdominal circumference and femur length. RESULTS Compared to the normal group, the median multiple of the median (MoM) values of UtA-PI and MAP were significantly higher in the SGA < 5(th) group. Combined screening by maternal factors, EFW Z-score, UtA-PI and MAP at 35-37 weeks predicted, at a 10% false-positive rate, 90%, 86% and 90% of SGA neonates with birth weight < 10(th) , < 5(th) and < 3(rd) percentiles, respectively, delivering < 2 weeks following assessment; the respective values for SGA delivering ≥ 37 weeks were 66%, 74% and 80%. Such performance was not significantly different from screening by maternal factors and EFW Z-score alone. CONCLUSION Addition of UtA-PI and MAP to combined testing by maternal factors and fetal biometry at 35-37 weeks does not improve the performance of screening for delivery of SGA neonates.
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Affiliation(s)
- C Fadigas
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - L Guerra
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - S Garcia-Tizon Larroca
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - L C Poon
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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Bakalis S, Silva M, Akolekar R, Poon LC, Nicolaides KH. Prediction of small-for-gestational-age neonates: screening by fetal biometry at 30-34 weeks. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:551-558. [PMID: 25523866 DOI: 10.1002/uog.14771] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 12/11/2014] [Accepted: 12/15/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the value of fetal biometry at 30-34 weeks' gestation in the prediction of delivery of small-for-gestational-age (SGA) neonates, in the absence of pre-eclampsia (PE). METHODS This was a screening study in 30 849 singleton pregnancies at 30-34 weeks' gestation, comprising 1727 that delivered SGA neonates with a birth weight < 5(th) percentile and 29 122 cases unaffected by SGA, PE or gestational hypertension. Multivariable logistic regression analysis was used to determine if screening by a combination of maternal factors and Z-scores of fetal head circumference (HC), abdominal circumference (AC) and femur length (FL) or estimated fetal weight (EFW) had a significant contribution to the prediction of SGA neonates. RESULTS Combined screening by maternal characteristics and obstetric history, with Z-scores of EFW at 30-34 weeks, predicted 79%, 87% and 92% of the SGA neonates that delivered < 5 weeks following assessment, with a birth weight < 10(th) , < 5(th) and < 3(rd) percentiles, respectively, at a 10% false-positive rate. The respective detection rates for the prediction of SGA neonates delivering ≥ 5 weeks from the time of assessment were 53%, 58% and 61%. The performance of screening by a combination of Z-scores of fetal HC, AC and FL was similar to that achieved by the EFW Z-score alone. CONCLUSION Combined testing by maternal characteristics and fetal biometry at 30-34 weeks could identify a high proportion of pregnancies that will deliver SGA neonates.
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Affiliation(s)
- S Bakalis
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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245
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Fadigas C, Saiid Y, Gonzalez R, Poon LC, Nicolaides KH. Prediction of small-for-gestational-age neonates: screening by fetal biometry at 35-37 weeks. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:559-565. [PMID: 25728139 DOI: 10.1002/uog.14816] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 02/03/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the value of fetal biometry at 35-37 weeks' gestation in the prediction of delivery of small-for-gestational-age (SGA) neonates, in the absence of pre-eclampsia (PE). METHODS This was a screening study in singleton pregnancies at 35-37 weeks' gestation, comprising 278 that delivered SGA neonates with a birth weight < 5th percentile and 5237 cases unaffected by SGA, PE or gestational hypertension. Multivariable logistic regression analysis was used to determine if screening by a combination of maternal factors and Z-scores of fetal head circumference (HC), abdominal circumference (AC) and femur length (FL) or estimated fetal weight (EFW) had a significant contribution to the prediction of SGA neonates. RESULTS Multivariable logistic regression analysis demonstrated that the likelihood of delivering a SGA neonate with a birth weight < 5th percentile decreased with maternal weight and height, and in parous women the risk increased with a longer interpregnancy interval. The risk was higher in women of Afro-Caribbean and South Asian racial origins, in cigarette smokers, nulliparous women and in those with history of SGA, with or without prior PE. Combined screening by maternal characteristics and history with EFW Z-scores at 35-37 weeks predicted 89% of SGA neonates with birth weight < 5th percentile delivering < 2 weeks following assessment, at a 10% false-positive rate (FPR). The respective detection rate for the prediction of SGA neonates delivering ≥ 37 weeks' gestation was 70%. The performance of screening by a combination of Z-scores of fetal HC, AC and FL was similar to that achieved by the EFW Z-score. CONCLUSION Combined testing by maternal characteristics and fetal biometry at 35-37 weeks could identify, at a 10% FPR, about 90% of pregnancies that subsequently deliver SGA neonates within 2 weeks of assessment and 70% of those that deliver ≥ 37 weeks.
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Affiliation(s)
- C Fadigas
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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246
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The role and regulation of IGFBP-1 phosphorylation in fetal growth restriction. J Cell Commun Signal 2015; 9:111-23. [PMID: 25682045 DOI: 10.1007/s12079-015-0266-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 01/21/2015] [Indexed: 12/18/2022] Open
Abstract
Fetal growth restriction (FGR) increases the risk of perinatal complications and predisposes the infant to developing metabolic, cardiovascular, and neurological diseases in childhood and adulthood. The pathophysiology underlying FGR remains poorly understood and there is no specific treatment available. Biomarkers for early detection are also lacking. The insulin-like growth factor (IGF) system is an important regulator of fetal growth. IGF-I is the primary regulator of fetal growth, and fetal circulating levels of IGF-I are decreased in FGR. IGF-I activity is influenced by a family of IGF binding proteins (IGFBPs), which bind to IGF-I and decrease its bioavailability. During fetal development the predominant IGF-I binding protein in fetal circulation is IGFBP-1, which is primarily secreted by the fetal liver. IGFBP-1 binds IGF-I and thereby inhibits its bioactivity. Fetal circulating levels of IGF-I are decreased and concentrations of IGFBP-1 are increased in FGR. Phosphorylation of human IGFBP-1 at specific sites markedly increases its binding affinity for IGF-I, further limiting IGF-I bioactivity. Recent experimental evidence suggests that IGFBP-1 phosphorylation is markedly increased in the circulation of FGR fetuses suggesting an important role of IGFBP-1 phosphorylation in the regulation of fetal growth. Understanding of the significance of site-specific IGFBP-1 phosphorylation and how it is regulated to contribute to fetal growth will be an important step in designing strategies for preventing, managing, and/or treating FGR. Furthermore, IGFBP-1 hyperphosphorylation at unique sites may serve as a valuable biomarker for FGR.
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247
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Pay ASD, Wiik J, Backe B, Jacobsson B, Strandell A, Klovning A. Symphysis-fundus height measurement to predict small-for-gestational-age status at birth: a systematic review. BMC Pregnancy Childbirth 2015; 15:22. [PMID: 25884884 PMCID: PMC4328041 DOI: 10.1186/s12884-015-0461-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/30/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Fetal growth restriction is among the most common and complex problems in modern obstetrics. Symphysis-fundus (SF) height measurement is a non-invasive test that may help determine which women are at risk. This study is a systematic review of the literature on the accuracy of SF height measurement for the prediction of small-for-gestational-age (SGA) status at birth in unselected and low-risk pregnancies. METHODS The Medline, Embase, Cinahl, SweMed, and Cochrane Library databases were searched with no limitation on publication date (through September 2014), which returned 722 citations. Two reviewers then developed a short list of 51 publications of possible relevance and assessed them using the following inclusion criteria: cohort study of test accuracy performed in a routine prenatal care setting; SF height measurement for all participants; classification of SGA, defined as birth weight (BW) < 10th, 5th, or 3rd percentile or ≥ one or two standard deviations below the mean; study conducted in Northern, Western, or Central Europe; USA; Canada; Australia; or New Zealand; and sufficient data for 2 × 2 table construction. Quality of the included studies was assessed in duplicate using criteria suggested by the Cochrane Collaboration. Review Manager 5.3 software was used to analyze the data, including plotting of summary receiver operating curve spaces. RESULTS Eight studies were included in the final dataset and seven were included in summary analyses. The sensitivity of SF height measurement for SGA (BW < 10(th) percentile) prediction ranged from 0.27 to 0.76 and specificity ranged from 0.79 to 0.92. Positive and negative likelihood ratios ranged from 1.91 to 9.09 and from 0.29 to 0.83, respectively. CONCLUSIONS SF height can serve as a clinical indicator along with other clinical findings, information about medical conditions, and previous obstetric history. However, SF height has high false-negative rates for SGA. Clinicians must understand the limitations of this test. The protocol has been registered in the international prospective register of systematic reviews, PROSPERO (Registration No. CRD42014008928, http://www.crd.york.ac.uk/prospero/display_record.asp?ID=CRD42014008928 ).
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Affiliation(s)
- Aase Serine D Pay
- Department of Obstetrics and Department of Gynecology, Women's and Children's Division, Oslo University Hospital, Oslo, Norway. .,Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway.
| | - Johanna Wiik
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden.
| | - Bjørn Backe
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Technology and Science, Trondheim University Hospital, Trondheim, Norway.
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden. .,Department of Genes and Environment, Norwegian Institute of Public Health, Oslo, Norway.
| | - Annika Strandell
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden.
| | - Atle Klovning
- Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
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Monier I, Blondel B, Ego A, Kaminiski M, Goffinet F, Zeitlin J. Poor effectiveness of antenatal detection of fetal growth restriction and consequences for obstetric management and neonatal outcomes: a
F
rench national study. BJOG 2014; 122:518-27. [DOI: 10.1111/1471-0528.13148] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2014] [Indexed: 11/30/2022]
Affiliation(s)
- I Monier
- Inserm UMR 1153 Obstetrical Perinatal and Pediatric Epidemiology Research Team (Epopé) Center for Epidemiology and Statistics Sorbonne Paris Cité DHU Risks in pregnancy Paris Descartes University Paris France
| | - B Blondel
- Inserm UMR 1153 Obstetrical Perinatal and Pediatric Epidemiology Research Team (Epopé) Center for Epidemiology and Statistics Sorbonne Paris Cité DHU Risks in pregnancy Paris Descartes University Paris France
| | - A Ego
- Inserm UMR 1153 Obstetrical Perinatal and Pediatric Epidemiology Research Team (Epopé) Center for Epidemiology and Statistics Sorbonne Paris Cité DHU Risks in pregnancy Paris Descartes University Paris France
- Clinical Research Center (CICO3) Grenoble University Hospital Grenoble France
| | - M Kaminiski
- Inserm UMR 1153 Obstetrical Perinatal and Pediatric Epidemiology Research Team (Epopé) Center for Epidemiology and Statistics Sorbonne Paris Cité DHU Risks in pregnancy Paris Descartes University Paris France
| | - F Goffinet
- Inserm UMR 1153 Obstetrical Perinatal and Pediatric Epidemiology Research Team (Epopé) Center for Epidemiology and Statistics Sorbonne Paris Cité DHU Risks in pregnancy Paris Descartes University Paris France
- Port‐Royal Maternity Unit Department of Obstetrics and Gynaecology Cochin University Hospital Assistance Publique Hôpitaux de Paris Paris France
| | - J Zeitlin
- Inserm UMR 1153 Obstetrical Perinatal and Pediatric Epidemiology Research Team (Epopé) Center for Epidemiology and Statistics Sorbonne Paris Cité DHU Risks in pregnancy Paris Descartes University Paris France
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Visentin S, Londero AP, Grumolato F, Trevisanuto D, Zanardo V, Ambrosini G, Cosmi E. Timing of delivery and neonatal outcomes for small-for-gestational-age fetuses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1721-1728. [PMID: 25253817 DOI: 10.7863/ultra.33.10.1721] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To investigate whether antenatal recognition of small-for-gestational-age (SGA) fetuses with normal maternal and fetal Doppler values delivered after 34 weeks' gestation is associated with changes in the risk of adverse maternal and neonatal outcomes. METHODS In this retrospective study, we included 313 singleton SGA fetuses and 313 appropriate-for-gestational-age control fetuses born between 34 and 42 weeks' gestation from 2009 to 2012. Small-for-gestational-age fetuses identified before delivery (n = 124), for whom antenatal surveillance was performed until delivery (estimated fetal weight twice weekly and Doppler evaluation of the fetal compartment once weekly), were compared to those not identified at delivery (n = 189). The latter group did not undergo antenatal surveillance for several reasons (women for whom a sonographic evaluation or gynecologic consultation was not performed in the third trimester and incorrect sonographic biometric evaluation in the third trimester). Main outcome measures were mode of delivery, perinatal complications, and neonatal intensive care unit admission. The risk of serious fetal complications was assessed by cross-tabulation analysis adjusted for gestational age and degree of SGA. RESULTS Prenatally recognized SGA fetuses were smaller and delivered earlier than unrecognized SGA fetuses (P< .05). Fetal acidemia (pH <7.10) was significantly more common in unrecognized SGA fetuses (3.7% versus 0%). Small-for-gestational-age fetuses at or below the 3rd percentile were more commonly recognized prenatally and hospitalized in the neonatal intensive care unit. Unrecognized SGA fetuses also had worse fetal outcomes compared to controls (P< .05). Recognized and unrecognized SGA fetuses were born significantly more frequently by cesarean delivery (P < .05). No significant differences in perinatal outcomes were found between recognized SGA deliveries with or without medical induction. CONCLUSIONS Antenatal recognition of SGA fetuses delivered after 34 weeks' gestation might improve perinatal outcomes. Medical induction of labor did not modify neonatal outcomes among prenatally recognized SGA fetuses.
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Affiliation(s)
- Silvia Visentin
- Department of Woman's and Child's Health, Maternal-Fetal Medicine Unit, University of Padua School of Medicine, Padua, Italy (S.V., F.G., D.T., V.Z., G.A., E.C.); and Clinic of Obstetrics and Gynecology, Department of Experimental Clinical and Medical Sciences, University of Udine, Udine, Italy (A.P.L.)
| | - Ambrogio Pietro Londero
- Department of Woman's and Child's Health, Maternal-Fetal Medicine Unit, University of Padua School of Medicine, Padua, Italy (S.V., F.G., D.T., V.Z., G.A., E.C.); and Clinic of Obstetrics and Gynecology, Department of Experimental Clinical and Medical Sciences, University of Udine, Udine, Italy (A.P.L.)
| | - Francesca Grumolato
- Department of Woman's and Child's Health, Maternal-Fetal Medicine Unit, University of Padua School of Medicine, Padua, Italy (S.V., F.G., D.T., V.Z., G.A., E.C.); and Clinic of Obstetrics and Gynecology, Department of Experimental Clinical and Medical Sciences, University of Udine, Udine, Italy (A.P.L.)
| | - Daniele Trevisanuto
- Department of Woman's and Child's Health, Maternal-Fetal Medicine Unit, University of Padua School of Medicine, Padua, Italy (S.V., F.G., D.T., V.Z., G.A., E.C.); and Clinic of Obstetrics and Gynecology, Department of Experimental Clinical and Medical Sciences, University of Udine, Udine, Italy (A.P.L.)
| | - Vincenzo Zanardo
- Department of Woman's and Child's Health, Maternal-Fetal Medicine Unit, University of Padua School of Medicine, Padua, Italy (S.V., F.G., D.T., V.Z., G.A., E.C.); and Clinic of Obstetrics and Gynecology, Department of Experimental Clinical and Medical Sciences, University of Udine, Udine, Italy (A.P.L.)
| | - Guido Ambrosini
- Department of Woman's and Child's Health, Maternal-Fetal Medicine Unit, University of Padua School of Medicine, Padua, Italy (S.V., F.G., D.T., V.Z., G.A., E.C.); and Clinic of Obstetrics and Gynecology, Department of Experimental Clinical and Medical Sciences, University of Udine, Udine, Italy (A.P.L.)
| | - Erich Cosmi
- Department of Woman's and Child's Health, Maternal-Fetal Medicine Unit, University of Padua School of Medicine, Padua, Italy (S.V., F.G., D.T., V.Z., G.A., E.C.); and Clinic of Obstetrics and Gynecology, Department of Experimental Clinical and Medical Sciences, University of Udine, Udine, Italy (A.P.L.).
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Aviram A, Yogev Y, Bardin R, Meizner I, Wiznitzer A, Hadar E. Small for gestational age newborns – does pre-recognition make a difference in pregnancy outcome? J Matern Fetal Neonatal Med 2014; 28:1520-4. [DOI: 10.3109/14767058.2014.961912] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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