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Souka AP, Antsaklis P, Tassias K, Chatziioannou MA, Papamihail M, Daskalakis G. The role of the PLGF in the prediction of the outcome in pregnancies with a small for gestational age fetus. Arch Gynecol Obstet 2024; 310:237-243. [PMID: 37837546 DOI: 10.1007/s00404-023-07214-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/30/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE To explore the value of measuring maternal serum PLGF in the prediction of the outcome of small for gestational age fetuses (SGA). METHODS Singleton pregnancies referred with suspicion of SGA in the third trimester were included if they had: no indication for nor signs of imminent delivery, fetal abdominal circumference (AC) at or below the 10th centile and/or estimated fetal weight (EFW) at or below the 10th centile and/or umbilical artery pulsatility index (Umb-PI) at or above the 90th centile for gestation. Women with pre-eclampsia at presentation were excluded. Maternal blood was drawn at the first (index) visit and analyzed retrospectively. RESULTS Fifty-one fetuses were examined. Multiple regression analysis showed that family history of microsomia, index EFW and PLGF were significant predictors of the birthweight centile; index femur length centile and PLGF were significant predictors of pre-eclampsia; PLGF and index systolic blood pressure were significant predictors of iatrogenic preterm delivery < 37 weeks, whereas PLGF and index EFW were significant predictors of birthweight ≤ 5th centile and admission to the neonatal intensive care unit. For all outcomes, the addition of maternal-fetal parameters did not improve the prediction compared to PLGF alone. Using a cutoff of 0.3 MoM for PLGF would identify 94.1% of the pregnancies with iatrogenic preterm delivery and/or intra-uterine death and all of the cases that developed pre-eclampsia, for a screen positive rate of 54.9%. Women with PLGF ≤ 0.3 MoM had a poor fetal/maternal outcome (iatrogenic preterm delivery, pre-eclampsia, intra-uterine death) in 61.5% of cases. CONCLUSION In pregnancies complicated by SGA, PLGF identifies a very high-risk group that may benefit from intense surveillance.
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Affiliation(s)
- Athena P Souka
- Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens-Faculty of Medicine, 41, D. Soutsou Str, 11521, Athens, Greece.
| | - Panagiotis Antsaklis
- Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens-Faculty of Medicine, 41, D. Soutsou Str, 11521, Athens, Greece
| | - Konstantinos Tassias
- Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens-Faculty of Medicine, 41, D. Soutsou Str, 11521, Athens, Greece
| | - Maria Anna Chatziioannou
- Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens-Faculty of Medicine, 41, D. Soutsou Str, 11521, Athens, Greece
| | - Maria Papamihail
- Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens-Faculty of Medicine, 41, D. Soutsou Str, 11521, Athens, Greece
| | - George Daskalakis
- Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens-Faculty of Medicine, 41, D. Soutsou Str, 11521, Athens, Greece
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Dieste-Pérez P, Savirón-Cornudella R, Tajada-Duaso M, Pérez-López FR, Castán-Mateo S, Sanz G, Esteban LM. Personalized Model to Predict Small for Gestational Age at Delivery Using Fetal Biometrics, Maternal Characteristics, and Pregnancy Biomarkers: A Retrospective Cohort Study of Births Assisted at a Spanish Hospital. J Pers Med 2022; 12:jpm12050762. [PMID: 35629184 PMCID: PMC9147008 DOI: 10.3390/jpm12050762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/29/2022] [Accepted: 05/05/2022] [Indexed: 01/25/2023] Open
Abstract
Small for gestational age (SGA) is defined as a newborn with a birth weight for gestational age < 10th percentile. Routine third-trimester ultrasound screening for fetal growth assessment has detection rates (DR) from 50 to 80%. For this reason, the addition of other markers is being studied, such as maternal characteristics, biochemical values, and biophysical models, in order to create personalized combinations that can increase the predictive capacity of the ultrasound. With this purpose, this retrospective cohort study of 12,912 cases aims to compare the potential value of third-trimester screening, based on estimated weight percentile (EPW), by universal ultrasound at 35−37 weeks of gestation, with a combined model integrating maternal characteristics and biochemical markers (PAPP-A and β-HCG) for the prediction of SGA newborns. We observed that DR improved from 58.9% with the EW alone to 63.5% with the predictive model. Moreover, the AUC for the multivariate model was 0.882 (0.873−0.891 95% C.I.), showing a statistically significant difference with EPW alone (AUC 0.864 (95% C.I.: 0.854−0.873)). Although the improvements were modest, contingent detection models appear to be more sensitive than third-trimester ultrasound alone at predicting SGA at delivery.
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Affiliation(s)
- Peña Dieste-Pérez
- Department of Obstetrics and Gynecology, Miguel Servet University Hospital and Aragón Health Research Institute, 50009 Zaragoza, Spain; (M.T.-D.); (S.C.-M.)
- Correspondence: (P.D.-P.); (L.M.E.)
| | - Ricardo Savirón-Cornudella
- Department of Obstetrics and Gynecology, San Carlos Clinical Hospital and San Carlos Health Research Institute (IdISSC), Complutense University, 28040 Madrid, Spain;
| | - Mauricio Tajada-Duaso
- Department of Obstetrics and Gynecology, Miguel Servet University Hospital and Aragón Health Research Institute, 50009 Zaragoza, Spain; (M.T.-D.); (S.C.-M.)
| | - Faustino R. Pérez-López
- Department of Obstetrics and Gynecology, University of Zaragoza Faculty of Medicine and Aragón Health Research Institute, 50009 Zaragoza, Spain;
| | - Sergio Castán-Mateo
- Department of Obstetrics and Gynecology, Miguel Servet University Hospital and Aragón Health Research Institute, 50009 Zaragoza, Spain; (M.T.-D.); (S.C.-M.)
| | - Gerardo Sanz
- Department of Statistical Methods and Institute for Biocomputation and Physics of Complex Systems-BIFI, University of Zaragoza,50018 Zaragoza, Spain;
| | - Luis Mariano Esteban
- Engineering School of La Almunia, University of Zaragoza, 50100 La Almunia de Doña Godina, Spain
- Correspondence: (P.D.-P.); (L.M.E.)
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Martín-Palumbo G, Duque Alcorta M, Atanasova VB, Rego Tejeda MT, Antolín Alvarado E, Bartha JL. Prenatal prediction of very late onset small-for-gestational age newborns in low-risk pregnancies. J Matern Fetal Neonatal Med 2022; 35:9816-9820. [PMID: 35341457 DOI: 10.1080/14767058.2022.2054322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To find a multivariate model for predicting small-for-gestational age newborns at 36 weeks' gestation by using clinical, biochemical and ultrasound measurements. MATERIALS AND METHODS We evaluated 564 low-risk pregnant women and recorded maternal age, maternal body mass index, maternal mean blood pressure, soluble fms-like tyrosine kinase-1 (multiples of the median), placental growth factor (multiples of the median), soluble fms-like tyrosine kinase-1/placental growth factor ratio, estimated fetal weight centile and mean uterine artery pulsatility index at 36 weeks. Binary logistic regression was used. Statistical significance was set at 95% level (p < 0.05). RESULTS We found three multivariate models showing relatively small differences in predictive capability. Model 1 only included estimated fetal weight centiles (area under the curve [AUC] 0.86; R2 = 0.42; p < 0.0001), Model 2 estimated fetal weight centiles and placental growth factor (multiples of the median) (AUC 0.87; R2 = 0.44; p < 0.0001) and Model 3 estimated fetal weight centiles, placental growth factor (multiples of the median) and mean uterine artery pulsatility index (AUC 0.88; R2 = 0.45; p < 0.0001). CONCLUSION Small-for-gestational age at delivery may be predicted by using a multivariate formula. The inclusion of parameters other than estimated fetal weight centile at 36 weeks' gestation modestly improves the predictive capability of the model. Clinical decisions should consider whether or not these slight differences deserve a change in current strategies.
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Affiliation(s)
- Giovanna Martín-Palumbo
- Division of Maternal and Fetal Medicine. Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
| | | | - Vangeliya Blagoeva Atanasova
- Division of Maternal and Fetal Medicine. Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
| | - María Teresa Rego Tejeda
- Division of Maternal and Fetal Medicine. Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
| | - Eugenia Antolín Alvarado
- Division of Maternal and Fetal Medicine. Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
| | - José Luis Bartha
- Division of Maternal and Fetal Medicine. Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
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López Soto Á, Velasco Martínez M, Meseguer González JL, López Pérez R. Third trimester ultrasound. A long-standing debate. Taiwan J Obstet Gynecol 2021; 60:401-404. [PMID: 33966720 DOI: 10.1016/j.tjog.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 12/25/2022] Open
Abstract
Third trimester ultrasound has long been in obstetrics a topic of debate. This issue is framed in a historical debate on the effectiveness of routine obstetrical ultrasound and two opposing trends originated in America and Europe, respectively. Primary function of this ultrasound has been to detect fetal growth restriction, but no study has shown evidence of improving perinatal outcomes. Other secondary functions are detection of fetal abnormalities or evaluation of fetal presentation, and they have also shown no evidence. Despite the continuous appearance of works in this regard, health policies of both american and european trends have not been modified. Future seems to show a prolongation of the stalemate. Those health systems with a universal third trimester policy should propose an optimization of the test, in order to improve the benefits and obtain data for future studies that could resolve this longstanding debate.
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Dhillon P, Kaur I, Singh K. Pregnancy-induced hypertension: Role of drug therapy and nutrition in the management of hypertension. PHARMANUTRITION 2021. [DOI: 10.1016/j.phanu.2021.100251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Vogel JP, Vannevel V, Robbers G, Gwako G, Lavin T, Adanikin A, Hlongwane T, Pattinson RC, Qureshi ZP, Oladapo OT. Prevalence of abnormal umbilical arterial flow on Doppler ultrasound in low-risk and unselected pregnant women: a systematic review. Reprod Health 2021; 18:38. [PMID: 33579315 PMCID: PMC7881445 DOI: 10.1186/s12978-021-01088-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background While Doppler ultrasound screening is beneficial for women with high-risk pregnancies, there is insufficient evidence on its benefits and harms in low- and unselected-risk pregnancies. This may be related to fewer events of abnormal Doppler flow, however the prevalence of absent or reversed end diastolic flow (AEDF or REDF) in such women is unknown. In this systematic review, we aimed to synthesise available data on the prevalence of AEDF or REDF. Methods We searched PubMed, Embase, CINAHL, CENTRAL and Global Index Medicus with no date, setting or language restrictions. All randomized or non-randomized studies reporting AEDF or REDF prevalence based on Doppler assessment of umbilical arterial flow > 20 weeks’ gestation were eligible. Two authors assessed eligibility and extracted data on primary (AEDF and REDF) and secondary (fetal, perinatal, and neonatal mortality, caesarean section) outcomes, with results presented descriptively. Results A total of 42 studies (18,282 women) were included. Thirty-six studies reported zero AEDF or REDF cases. However, 55 AEDF or REDF cases were identified from just six studies (prevalence 0.08% to 2.13%). Four of these studies were in unselected-risk women and five were conducted in high-income countries. There was limited evidence from low- and middle-income countries. Conclusions Evidence from largely observational studies in higher-income countries suggests that AEDF and REDF are rare among low- and unselected-risk pregnant women. There are insufficient data from lower-income countries and further research is required.
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Affiliation(s)
- Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, 3000, Australia.
| | - Valerie Vannevel
- South African Medical Research Council/University of Pretoria Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Unit Private Bag X323 Arcadia, Pretoria, 0007, South Africa
| | - Gianna Robbers
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, 3000, Australia
| | - George Gwako
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - Tina Lavin
- School of Population and Global Health, University of Western Australia, Hackett Drive, Crawley, Perth, Australia.,UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Abiodun Adanikin
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Tsakane Hlongwane
- South African Medical Research Council/University of Pretoria Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Unit Private Bag X323 Arcadia, Pretoria, 0007, South Africa
| | - Robert C Pattinson
- South African Medical Research Council/University of Pretoria Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Unit Private Bag X323 Arcadia, Pretoria, 0007, South Africa
| | - Zahida P Qureshi
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - Olufemi T Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Fatihoglu E, Aydin S. Diagnosing Small for Gestational Age during second trimester routine screening: Early sonographic clues. Taiwan J Obstet Gynecol 2020; 59:287-292. [PMID: 32127152 DOI: 10.1016/j.tjog.2020.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Small for gestational age (SGA) is generally defined as birth weight being at or below the 10th percentile. Children with SGA have a higher risk for complications. There is a need for early predictors, as the accurate diagnosis rate is only 50%. In the current study, we aimed to evaluate diagnostic performance of ultrasound (US)/color Doppler ultrasound (CDUS) parameters (umbilical vein-UV, right portal vein-RPV diameter/flow rate, and portal sinus-PS diameter) examined at 20-22 gestational week as SGA diagnostic factors. MATERIALS AND METHODS 93 pregnant included (32 SGA, 61 controls). All the US examinations were performed between 20 and 22 weeks of gestation. UV, RPV, and PS measurements were performed by using the same image acquired for abdominal circumference measurement. A fetus with as estimated fetal weight (EFW) below the 10th percentile was diagnosed as SGA and SGA at birth was defined as having a birth weight under the 10th percentile. RESULTS Pregnant women in the SGA group were significantly older (30 ± 4.8 vs. 26.6 ± 5.4 years, p < 0.01). Median UV diameter was significantly lower in SGA group (2.20 vs. 2.40 mm, p = 0.001). Median RPV diameter was significantly lower in SGA group (2 vs. 2.10 mm, p = 0.018). Median PS diameter was significantly lower in SGA group (2 vs. 20.10 mm, p = 0.008). CONCLUSION UV, RPV, and PS diameters can be earlier predictors for SGA diagnosis. Routinely evaluation of these parameters during second trimester screening can increase SGA diagnosis rates and serve for early diagnose.
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Affiliation(s)
- Erdem Fatihoglu
- Medical Doctor, Erzincan University, Department of Radiology, Erzincan, Turkey
| | - Sonay Aydin
- Medical Doctor, Dr. Sami Ulus Training and Research Hospital, Department of Radiology, Ankara, Turkey.
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Heazell AEP, Hayes DJL, Whitworth M, Takwoingi Y, Bayliss SE, Davenport C. Biochemical tests of placental function versus ultrasound assessment of fetal size for stillbirth and small-for-gestational-age infants. Cochrane Database Syst Rev 2019; 5:CD012245. [PMID: 31087568 PMCID: PMC6515632 DOI: 10.1002/14651858.cd012245.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Stillbirth affects 2.6 million pregnancies worldwide each year. Whilst the majority of cases occur in low- and middle-income countries, stillbirth remains an important clinical issue for high-income countries (HICs) - with both the UK and the USA reporting rates above the mean for HICs. In HICs, the most frequently reported association with stillbirth is placental dysfunction. Placental dysfunction may be evident clinically as fetal growth restriction (FGR) and small-for-dates infants. It can be caused by placental abruption or hypertensive disorders of pregnancy and many other disorders and factorsPlacental abnormalities are noted in 11% to 65% of stillbirths. Identification of FGA is difficult in utero. Small-for-gestational age (SGA), as assessed after birth, is the most commonly used surrogate measure for this outcome. The degree of SGA is associated with the likelihood of FGR; 30% of infants with a birthweight < 10th centile are thought to be FGR, while 70% of infants with a birthweight < 3rd centile are thought to be FGR. Critically, SGA is the most significant antenatal risk factor for a stillborn infant. Correct identification of SGA infants is associated with a reduction in the perinatal mortality rate. However, currently used tests, such as measurement of symphysis-fundal height, have a low reported sensitivity and specificity for the identification of SGA infants. OBJECTIVES The primary objective was to assess and compare the diagnostic accuracy of ultrasound assessment of fetal growth by estimated fetal weight (EFW) and placental biomarkers alone and in any combination used after 24 weeks of pregnancy in the identification of placental dysfunction as evidenced by either stillbirth, or birth of a SGA infant. Secondary objectives were to investigate the effect of clinical and methodological factors on test performance. SEARCH METHODS We developed full search strategies with no language or date restrictions. The following sources were searched: MEDLINE, MEDLINE In Process and Embase via Ovid, Cochrane (Wiley) CENTRAL, Science Citation Index (Web of Science), CINAHL (EBSCO) with search strategies adapted for each database as required; ISRCTN Registry, UK Clinical Trials Gateway, WHO International Clinical Trials Portal and ClinicalTrials.gov for ongoing studies; specialist abstract and conference proceeding resources (British Library's ZETOC and Web of Science Conference Proceedings Citation Index). Search last conducted in Ocober 2016. SELECTION CRITERIA We included studies of pregnant women of any age with a gestation of at least 24 weeks if relevant outcomes of pregnancy (live birth/stillbirth; SGA infant) were assessed. Studies were included irrespective of whether pregnant women were deemed to be low or high risk for complications or were of mixed populations (low and high risk). Pregnancies complicated by fetal abnormalities and multi-fetal pregnancies were excluded as they have a higher risk of stillbirth from non-placental causes. With regard to biochemical tests, we included assays performed using any technique and at any threshold used to determine test positivity. DATA COLLECTION AND ANALYSIS We extracted the numbers of true positive, false positive, false negative, and true negative test results from each study. We assessed risk of bias and applicability using the QUADAS-2 tool. Meta-analyses were performed using the hierarchical summary ROC model to estimate and compare test accuracy. MAIN RESULTS We included 91 studies that evaluated seven tests - blood tests for human placental lactogen (hPL), oestriol, placental growth factor (PlGF) and uric acid, ultrasound EFW and placental grading and urinary oestriol - in a total of 175,426 pregnant women, in which 15,471 pregnancies ended in the birth of a small baby and 740 pregnancies which ended in stillbirth. The quality of included studies was variable with most domains at low risk of bias although 59% of studies were deemed to be of unclear risk of bias for the reference standard domain. Fifty-three per cent of studies were of high concern for applicability due to inclusion of only high- or low-risk women.Using all available data for SGA (86 studies; 159,490 pregnancies involving 15,471 SGA infants), there was evidence of a difference in accuracy (P < 0.0001) between the seven tests for detecting pregnancies that are SGA at birth. Ultrasound EFW was the most accurate test for detecting SGA at birth with a diagnostic odds ratio (DOR) of 21.3 (95% CI 13.1 to 34.6); hPL was the most accurate biochemical test with a DOR of 4.78 (95% CI 3.21 to 7.13). In a hypothetical cohort of 1000 pregnant women, at the median specificity of 0.88 and median prevalence of 19%, EFW, hPL, oestriol, urinary oestriol, uric acid, PlGF and placental grading will miss 50 (95% CI 32 to 68), 116 (97 to 133), 124 (108 to 137), 127 (95 to 152), 139 (118 to 154), 144 (118 to 161), and 144 (122 to 161) SGA infants, respectively. For the detection of pregnancies ending in stillbirth (21 studies; 100,687 pregnancies involving 740 stillbirths), in an indirect comparison of the four biochemical tests, PlGF was the most accurate test with a DOR of 49.2 (95% CI 12.7 to 191). In a hypothetical cohort of 1000 pregnant women, at the median specificity of 0.78 and median prevalence of 1.7%, PlGF, hPL, urinary oestriol and uric acid will miss 2 (95% CI 0 to 4), 4 (2 to 8), 6 (6 to 7) and 8 (3 to 13) stillbirths, respectively. No studies assessed the accuracy of ultrasound EFW for detection of pregnancy ending in stillbirth. AUTHORS' CONCLUSIONS Biochemical markers of placental dysfunction used alone have insufficient accuracy to identify pregnancies ending in SGA or stillbirth. Studies combining U and placental biomarkers are needed to determine whether this approach improves diagnostic accuracy over the use of ultrasound estimation of fetal size or biochemical markers of placental dysfunction used alone. Many of the studies included in this review were carried out between 1974 and 2016. Studies of placental substances were mostly carried out before 1991 and after 2013; earlier studies may not reflect developments in test technology.
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Affiliation(s)
- Alexander EP Heazell
- University of ManchesterMaternal and Fetal Health Research Centre5th floor (Research), St Mary's Hospital, Oxford RoadManchesterUKM13 9WL
| | - Dexter JL Hayes
- University of ManchesterMaternal and Fetal Health Research Centre5th floor (Research), St Mary's Hospital, Oxford RoadManchesterUKM13 9WL
| | - Melissa Whitworth
- University of ManchesterMaternal and Fetal Health Research Centre5th floor (Research), St Mary's Hospital, Oxford RoadManchesterUKM13 9WL
| | - Yemisi Takwoingi
- University of BirminghamInstitute of Applied Health ResearchEdgbastonBirminghamUKB15 2TT
| | - Susan E Bayliss
- University of BirminghamInstitute of Applied Health ResearchEdgbastonBirminghamUKB15 2TT
| | - Clare Davenport
- University of BirminghamInstitute of Applied Health ResearchEdgbastonBirminghamUKB15 2TT
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Caradeux J, Martinez-Portilla RJ, Peguero A, Sotiriadis A, Figueras F. Diagnostic performance of third-trimester ultrasound for the prediction of late-onset fetal growth restriction: a systematic review and meta-analysis. Am J Obstet Gynecol 2019; 220:449-459.e19. [PMID: 30633918 DOI: 10.1016/j.ajog.2018.09.043] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/25/2018] [Accepted: 09/04/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The objective of the study was to establish the diagnostic performance of ultrasound screening for predicting late smallness for gestational age and/or fetal growth restriction. DATA SOURCES A systematic search was performed to identify relevant studies published since 2007 in English, Spanish, French, Italian, or German, using the databases PubMed, ISI Web of Science, and SCOPUS. STUDY ELIGIBILITY CRITERIA We used rrospective and retrospective cohort studies in low-risk or nonselected singleton pregnancies with screening ultrasound performed at ≥32 weeks of gestation. STUDY APPRAISAL AND SYNTHESIS METHODS The estimated fetal weight and fetal abdominal circumference were assessed as index tests for the prediction of birthweight <10th (i.e. smallness for gestational age), less than the fifth, and less than the third centile and fetal growth restriction (estimated fetal weight less than the third or estimated fetal weight <10th plus Doppler signs). Quality of the included studies was independently assessed by 2 reviewers, using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. For the meta-analysis, hierarchical summary receiver-operating characteristic curves were constructed, and quantitative data synthesis was performed using random-effects models. The sensitivity of the abdominal circumference <10th centile and estimated fetal weight <10th centile for a fixed 10% false-positive rate was derived from the corresponding hierarchical summary receiver-operating characteristic curves. Heterogeneity between studies was visually assessed using Galbraith plots, and publication bias was assessed by funnel plots and quantified by Deeks' method. RESULTS A total of 21 studies were included. Observed pooled sensitivities of abdominal circumference and estimated fetal weight <10th centile for birthweight <10th centile were 35% (95% confidence interval, 20-52%) and 38% (95% confidence interval, 31-46%), respectively. Observed pooled specificities were 97% (95% confidence interval, 95-98%) and 95% (95% confidence interval, 93-97%), respectively. Modeled sensitivities of abdominal circumference and estimated fetal weight <10th centile for 10% false-positive rate were 78% (95% confidence interval, 61-95%) and 54% (95% confidence interval, 46-52%), respectively. The sensitivity of estimated fetal weight <10th centile was better when aimed to fetal growth restriction than to smallness for gestational age. Meta-regression analysis showed a significant increase in sensitivity when ultrasound evaluation was performed later in pregnancy (P = .001). CONCLUSION Third-trimester abdominal circumference and estimated fetal weight perform similar in predicting smallness for gestational age. However, for a fixed 10% false-positive rate extrapolated sensitivity is higher for abdominal circumference. There is evidence of better performance when the scan is performed near term and when fetal growth restriction is the targeted condition.
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Ciobanu A, Rouvali A, Syngelaki A, Akolekar R, Nicolaides KH. Prediction of small for gestational age neonates: screening by maternal factors, fetal biometry, and biomarkers at 35-37 weeks' gestation. Am J Obstet Gynecol 2019; 220:486.e1-486.e11. [PMID: 30707967 DOI: 10.1016/j.ajog.2019.01.227] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 01/17/2019] [Accepted: 01/22/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Small for gestational age (SGA) neonates are at increased risk for perinatal mortality and morbidity; however, the risks can be substantially reduced if the condition is identified prenatally, because in such cases close monitoring and appropriate timing of delivery and prompt neonatal care can be undertaken. The traditional approach of identifying pregnancies with SGA fetuses is maternal abdominal palpation and serial measurements of symphysial-fundal height, but the detection rate of this approach is less than 30%. A higher performance of screening for SGA is achieved by sonographic fetal biometry during the third trimester; screening at 30-34 weeks' gestation identifies about 80% of SGA neonates delivering preterm but only 50% of those delivering at term, at a screen-positive rate of 10%. There is some evidence that routine ultrasound examination at 36 weeks' gestation is more effective than that at 32 weeks in predicting birth of SGA neonates. OBJECTIVE To investigate the potential value of maternal characteristics and medical history, sonographically estimated fetal weight (EFW) and biomarkers of impaired placentation at 35+0- 36+6 weeks' gestation in the prediction of delivery of SGA neonates. MATERIALS AND METHODS A dataset of 19,209 singleton pregnancies undergoing screening at 35+0-36+6 weeks' gestation was divided into a training set and a validation set. The training dataset was used to develop models from multivariable logistic regression analysis to determine whether the addition of uterine artery pulsatility index (UtA-PI), umbilical artery PI (UA-PI), fetal middle cerebral artery PI (MCA-PI), maternal serum placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFLT) would improve the performance of maternal factors and EFW in the prediction of delivery of SGA neonates. The models were then tested in the validation dataset to assess performance of screening. RESULTS First, in the training dataset, in the SGA group, compared to those with birthweight in ≥10th percentile, the median multiple of the median (MoM) values of PlGF and MCA-PI were reduced, whereas UtA-PI, UA-PI, and sFLT were increased. Second, multivariable regression analysis demonstrated that in the prediction of SGA in <10th percentile there were significant contributions from maternal factors, EFW Z-score, UtA-PI MoM, MCA-PI MoM, and PlGF MoM. Third, in the validation dataset, prediction of 90% of SGA neonates delivering within 2 weeks of assessment was achieved by a screen-positive rate of 67% (95% confidence interval [CI], 64-70%) in screening by maternal factors, 23% (95% CI, 20-26%) by maternal factors, and EFW and 21% (95% CI, 19-24%) by the addition of biomarkers. Fourth, prediction of 90% of SGA neonates delivering at any stage after assessment was achieved by a screen-positive rate of 66% (95% CI, 65-67%) in screening by maternal factors, 32% (95% CI, 31-33%) by maternal factors and EFW and 30% (95% CI, 29-31%) by the addition of biomarkers. CONCLUSION The addition of biomarkers of impaired placentation only marginally improves the predictive performance for delivery of SGA neonates achieved by maternal factors and fetal biometry at 35+0-36+6 weeks' gestation.
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Simeonova-Brachot II. Prediction of SGA at Birth by Using the Right Portal Vein Diameter Measurement at the 30-35-Week Scan. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 41:316-326. [PMID: 30316713 DOI: 10.1016/j.jogc.2018.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 04/27/2018] [Accepted: 05/01/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study sought to test the hypothesis that the measurement of the right portal vein (RPV) diameter on the transverse abdominal view at the 32-week ultrasound scan is small in fetuses with growth retardation and to validate the use of this measurement as a tool for detecting small for gestational age (SGA) at birth. METHODS This was a retrospective cohort study at a single centre. The study population comprised 326 consecutive pregnancies, including 29 SGA at delivery and 297 unaffected cases. Stored images of the transverse view of the abdomen, obtained at the routine third trimester scan, were used to assess the diameters of the umbilical vein, the portal sinus, and the RPV. RESULTS The portal sinus and RPV diameter were smaller compared with the reference group (P = 0.021 and P < 0.001, respectively). Using a 10th percentile cut-off, the detection rate for SGA at birth was 38% for the RPV diameter versus 45% for the estimated fetal weight. The false-positive rates were 9% versus 8%, respectively. Multiple regression analysis revealed that RPV below the 10th percentile remained an independent four-fold risk factor for SGA (odds ratio [OR] 5.05; 95% confidence interval [CI] 1.94-13.14). Further analysis revealed a higher prevalence of induction of labour for non-reassuring fetal well-being (P = 0.005), fetal acidemia (P = 0.028), and admission to a neonatal intensive care unit (NICU, P = 0.029) in the RPV ≤10th percentile group. CONCLUSION RPV below the 10th percentile could be a reliable third trimester ultrasound marker of a subnormal fetal environment. This study proposed a new and accessible approach for prediction of SGA.
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Papastefanou I, Chrelias C, Siristatidis C, Kappou D, Eleftheriades M, Kassanos D. Placental volume at 11 to 14 gestational weeks in pregnancies complicated with fetal growth restriction and preeclampsia. Prenat Diagn 2018; 38:928-935. [PMID: 30188581 DOI: 10.1002/pd.5356] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 08/26/2018] [Accepted: 08/29/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The study aims to evaluate the predictive value of first trimester placental volume in pregnancies destined to develop fetal growth restriction (FGR) and preeclampsia (PE). METHODS Prospective observational study including placentas from 34 FGR, 12 PE, 15 GH (gestational hypertension) pregnancies, and 265 controls. Placental volume (PV) was obtained using VOCAL technique, and a z score was calculated (z-PV). The association of PV with other first trimester variables and maternal characteristics was assessed with Spearman's correlation. RESULTS PV increased exponentially with crown-rump length (CRL) and was unrelated to maternal factors (weight, age, parity, and smoking status) as well as first trimester uterine artery Doppler, free β-hCG, nuchal translucency, or fetal heart rate. However, PV was positively associated with maternal height, CRL, PAPP-A, and birth weight. z-PV was a strong predictor for FGR with abnormal fetal Dopplers (AUC = 0.9472, P < 0.001). z-PV provided moderate prediction of FGR with normal fetal Dopplers (AUC = 0.8396, P < 0.001), PE (AUC = 0.8312, P < 0.001), and GH (AUC = 0.7640, P < 0.001). The addition of maternal weight, PAPP-A, β-hCG, and uterine artery Doppler improved our models. CONCLUSION At 11 to 14 weeks, PV is an independent predictor of pregnancy complications related to placental insufficiency, and the predictive ability is greater for FGR pregnancies with abnormal fetal Dopplers.
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Affiliation(s)
- Ioannis Papastefanou
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology, Athens Medical School, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, Greece
| | - Charalambos Chrelias
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology, Athens Medical School, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, Greece
| | - Charalambos Siristatidis
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology, Athens Medical School, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, Greece
| | - Dimitra Kappou
- Department of Obstetrics and Gynaecology, Royal Free Hospital, London, UK
| | - Makarios Eleftheriades
- 2nd Department of Obstetrics and Gynecology, University of Athens Medical School, Aretaieio Hospital, Athens, Greece
| | - Dimitrios Kassanos
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology, Athens Medical School, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, Greece
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King K, Foo J, Hazelton K, Henry A. Selective versus universal third trimester ultrasound: Time for a rethink? An audit of current practices at a metropolitan Sydney hospital. Australas J Ultrasound Med 2018; 21:96-103. [PMID: 34760509 PMCID: PMC8411926 DOI: 10.1002/ajum.12082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Routine third-trimester ultrasound (T3US) is not recommended in evidence-based clinical guidelines despite occurring frequently. This study investigated the incidence, indication for, results and follow-up needs of T3US performed at a Sydney metropolitan teaching hospital. METHODS Audit of T3US amongst singleton pregnancies at St George Hospital, Sydney: retrospective review October-December 2012, prospective cohort with clinician survey February-April 2013. Data included are as follows: maternal demographics, aneuploidy screening results, T3US ordering patterns, results, follow-up management and pregnancy outcomes. Comparison of demographic characteristics and pregnancy outcomes was performed for women undergoing T3US vs. no T3US. RESULTS One thousand and thirty-five women (623 retrospective, 412 prospective) were included, of whom 560 (54%) received at least one T3US. Characteristics of retrospective and prospective cohorts were similar, so combined data are presented. Most initial T3USs were for valid indications (463 of 560; 83%), most frequently low-lying placenta at morphology (19%), reduced fundal height (10%) and to follow-up fetal concerns at morphology ultrasound (9%). One hundred and sixty-two out of 560 (29%) of initial T3US were not normal, predominantly related to accelerated or reduced fetal growth. Detection of SGA babies was significantly higher in the T3US group (32% SGA babies detected vs. 0% if no T3US, P < 0.001). However, overall detection rates remained low, with 5.2% and 3.0% of babies who had a T3US unexpectedly <10th and <3rd centile birthweight, respectively. DISCUSSION/CONCLUSION The majority of women received at least one, usually indicated, T3US in routine practice at our metropolitan Sydney hospital. This may impact obstetric care, resource allocation and patient well-being. Detection of small for gestational age fetuses was poor.
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Affiliation(s)
- Kristina King
- Department of Women's and Children's HealthSt George Hospital28 Gray StKogarah2217New South WalesAustralia
| | - Jinny Foo
- Department of Women's and Children's HealthSt George Hospital28 Gray StKogarah2217New South WalesAustralia
| | - Kirsty Hazelton
- University of Aberdeen College of Life Sciences and MedicineKings CollegeAberdeen AB24 3FXUK
| | - Amanda Henry
- School of Women's and Children's HealthUniversity of New South WalesLevel 1, Royal Hospital for Women Barker St, RandwickSydneyNew South WalesAustralia
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Miranda J, Paules C, Nair S, Lai A, Palma C, Scholz-Romero K, Rice GE, Gratacos E, Crispi F, Salomon C. Placental exosomes profile in maternal and fetal circulation in intrauterine growth restriction - Liquid biopsies to monitoring fetal growth. Placenta 2018; 64:34-43. [PMID: 29626979 DOI: 10.1016/j.placenta.2018.02.006] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 02/19/2018] [Accepted: 02/21/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Placenta-derived exosomes may represent an additional pathway by which the placenta communicates with the maternal system to induce maternal vascular adaptations to pregnancy and it may be affected during Fetal growth restriction (FGR). The objective of this study was to quantify the concentration of total and placenta-derived exosomes in maternal and fetal circulation in small fetuses classified as FGR or small for gestational age (SGA). METHODS Prospective cohort study in singleton term gestations including 10 normally grown fetuses and 20 small fetuses, sub-classified into SGA and FGR accordingly to birth weight (BW) percentile and fetoplacental Doppler. Exosomes were isolated from maternal and fetal plasma and characterized by morphology, enrichment of exosomal proteins, and size distribution by electron microscopy, western blot, and nanoparticle tracking analysis, respectively. Total and specific placenta-derived exosomes were determined using quantum dots coupled with CD63+ve and placental-type alkaline phosphatase (PLAP)+ve antibodies, respectively. RESULTS Maternal concentrations of CD63+ve and PLAP+ve exosomes were similar between the groups (all p > 0.05). However, there was a significant positive correlation between the ratio of placental-derived to total exosomes (PLAP+ve ratio) and BW percentile, [rho = 0.77 (95% CI: 0.57 to 0.89); p = 0.0001]. The contribution of placental exosomes to the total exosome concentration in maternal and fetal circulation showed a significant decrease among cases, with lower PLAP+ve ratios in FGR compared to controls and SGA cases. DISCUSSION Quantification of placental exosomes in maternal plasma reflects fetal growth and it may be a useful indicator of placental function.
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Affiliation(s)
- Jezid Miranda
- Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), ICGON, IDIBAPS, Universitat de Barcelona, Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Cristina Paules
- Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), ICGON, IDIBAPS, Universitat de Barcelona, Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Soumyalekshmi Nair
- Exosome Biology Laboratory, Centre for Clinical Diagnostics, UQ Centre for Clinical Research, Royal Brisbane and Women's Hospital, Faculty of Medicine + Biomedical Sciences, The University of Queensland, Australia
| | - Andrew Lai
- Exosome Biology Laboratory, Centre for Clinical Diagnostics, UQ Centre for Clinical Research, Royal Brisbane and Women's Hospital, Faculty of Medicine + Biomedical Sciences, The University of Queensland, Australia
| | - Carlos Palma
- Exosome Biology Laboratory, Centre for Clinical Diagnostics, UQ Centre for Clinical Research, Royal Brisbane and Women's Hospital, Faculty of Medicine + Biomedical Sciences, The University of Queensland, Australia
| | - Katherin Scholz-Romero
- Exosome Biology Laboratory, Centre for Clinical Diagnostics, UQ Centre for Clinical Research, Royal Brisbane and Women's Hospital, Faculty of Medicine + Biomedical Sciences, The University of Queensland, Australia
| | - Gregory E Rice
- Exosome Biology Laboratory, Centre for Clinical Diagnostics, UQ Centre for Clinical Research, Royal Brisbane and Women's Hospital, Faculty of Medicine + Biomedical Sciences, The University of Queensland, Australia; Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, University of Concepción, Concepción, Chile
| | - Eduard 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), ICGON, IDIBAPS, Universitat de Barcelona, Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Fatima 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), ICGON, IDIBAPS, Universitat de Barcelona, Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Carlos Salomon
- Exosome Biology Laboratory, Centre for Clinical Diagnostics, UQ Centre for Clinical Research, Royal Brisbane and Women's Hospital, Faculty of Medicine + Biomedical Sciences, The University of Queensland, Australia; Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, University of Concepción, Concepción, Chile.
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Miranda J, Rodriguez-Lopez M, Triunfo S, Sairanen M, Kouru H, Parra-Saavedra M, Crovetto F, Figueras F, Crispi F, Gratacós E. Prediction of fetal growth restriction using estimated fetal weight vs a combined screening model in the third trimester. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:603-611. [PMID: 28004439 DOI: 10.1002/uog.17393] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 10/16/2016] [Accepted: 12/16/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To compare the performance of third-trimester screening, based on estimated fetal weight centile (EFWc) vs a combined model including maternal baseline characteristics, fetoplacental ultrasound and maternal biochemical markers, for the prediction of small-for-gestational-age (SGA) neonates and late-onset fetal growth restriction (FGR). METHODS This was a nested case-control study within a prospective cohort of 1590 singleton gestations undergoing third-trimester (32 + 0 to 36 + 6 weeks' gestation) evaluation. Maternal baseline characteristics, mean arterial pressure, fetoplacental ultrasound and circulating biochemical markers (placental growth factor (PlGF), lipocalin-2, unconjugated estriol and inhibin A) were assessed in all women who subsequently delivered a SGA neonate (n = 175), defined as birth weight < 10th centile according to customized standards, and in a control group (n = 875). Among SGA cases, those with birth weight < 3rd centile and/or abnormal uterine artery pulsatility index (UtA-PI) and/or abnormal cerebroplacental ratio (CPR) were classified as FGR. Logistic regression predictive models were developed for SGA and FGR, and their performance was compared with that obtained using EFWc alone. RESULTS In SGA cases, EFWc, CPR Z-score and maternal serum concentrations of unconjugated estriol and PlGF were significantly lower, while mean UtA-PI Z-score and lipocalin-2 and inhibin A concentrations were significantly higher, compared with controls. Using EFWc alone, 52% (area under receiver-operating characteristics curve (AUC), 0.82 (95% CI, 0.77-0.85)) of SGA and 64% (AUC, 0.86 (95% CI, 0.81-0.91)) of FGR cases were predicted at a 10% false-positive rate. A combined screening model including a-priori risk (maternal characteristics), EFWc, UtA-PI, PlGF and estriol (with lipocalin-2 for SGA) achieved a detection rate of 61% (AUC, 0.86 (95% CI, 0.83-0.89)) for SGA cases and 77% (AUC, 0.92 (95% CI, 0.88-0.95)) for FGR. The combined model for the prediction of SGA and FGR performed significantly better than did using EFWc alone (P < 0.001 and P = 0.002, respectively). CONCLUSIONS A multivariable integrative model of maternal characteristics, fetoplacental ultrasound and maternal biochemical markers modestly improved the detection of SGA and FGR cases at 32-36 weeks' gestation when compared with screening based on EFWc alone. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J Miranda
- BCNatal - 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), Barcelona, Spain
| | - M Rodriguez-Lopez
- BCNatal - 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), Barcelona, Spain
| | - S Triunfo
- BCNatal - 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), Barcelona, Spain
| | | | - H Kouru
- PerkinElmer, Inc., Turku, Finland
| | - M Parra-Saavedra
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, IDIBAPS, University of Barcelona, Spain
- Maternal-Fetal Unit, CEDIFETAL, Centro de Diagnostico de Ultrasonido e Imágenes, CEDIUL, Barranquilla, Colombia
| | - F Crovetto
- BCNatal - 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), 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, Spain
- 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, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - E Gratacós
- BCNatal - 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), Barcelona, Spain
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Policiano C, Fonseca A, Mendes JM, Clode N, Graça LM. Small-for-gestational-age babies of low-risk term pregnancies: does antenatal detection matter? J Matern Fetal Neonatal Med 2017; 31:1426-1430. [PMID: 28391748 DOI: 10.1080/14767058.2017.1317741] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To compare delivery route and admission rate to neonatal intensive care unit between small- and appropriate-for-gestational-age babies among low-risk term pregnancies. METHODS A retrospective study was conducted using the database of deliveries in 2014 at a tertiary hospital. Babies delivered at ≥37 weeks with birthweight <10th centile were considered small-for-gestational-age (SGA) and >90th centile were considered large-for-gestational-age. Fetal weight estimation at 30-33 weeks ultrasound <10th centile was considered antenatal detection of SGA. RESULTS Among 1429 low-risk term pregnancies, 11% (151/1429) had SGA babies and 5% (75/1429) had large-for-gestational-age. SGA babies were associated with higher rate of cesarean sections for nonreassuring fetal status (18/151 versus 8/1202, p < .001) and higher rate of admissions to neonatal intensive care unit (16/151 versus 18/1202, p < .001) compared to appropriate-for-gestational-age. Within SGA group, antepartum detected fetuses were associated with lower rate of operative deliveries for nonreassuring fetal status than undetected group (3/31 versus 39/120, p = .01) Conclusions: In our series, women with SGA term babies were associated with more adverse obstetric and neonatal outcome than appropriate-for-gestational age, especially among those undetected prenatally.
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Affiliation(s)
- Catarina Policiano
- a Department of Obstetrics and Gynecology , CHLN-Hospital Universitário de Santa Maria , Lisbon , Portugal
| | - Andreia Fonseca
- a Department of Obstetrics and Gynecology , CHLN-Hospital Universitário de Santa Maria , Lisbon , Portugal
| | - Jorge M Mendes
- b NOVAIMS, Universidade Nova de Lisboa , Lisbon , Portugal
| | - Nuno Clode
- a Department of Obstetrics and Gynecology , CHLN-Hospital Universitário de Santa Maria , Lisbon , Portugal
| | - Luís M Graça
- c Faculdade de Medicina da Universidade de Lisboa, CAM-Centro Académico de Medicina de Lisboa , Lisbon , Portugal
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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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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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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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Nguyen PH, Addo OY, Young M, Gonzalez-Casanova I, Pham H, Truong TV, Nguyen S, Martorell R, Ramakrishnan U. Patterns of Fetal Growth Based on Ultrasound Measurement and its Relationship with Small for Gestational Age at Birth in Rural Vietnam. Paediatr Perinat Epidemiol 2016; 30:256-66. [PMID: 26848715 DOI: 10.1111/ppe.12276] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Small for gestational age (SGA) is a global health problem. Identifying the timing of fetal growth faltering is critical for developing preventive interventions. We aim to describe patterns of fetal growth and to predict SGA at birth using fetal ultrasound measurements. METHODS We studied 1412 pregnant women enrolled in a randomised-controlled trial evaluating maternal micronutrient supplementation in Thai Nguyen province, Vietnam. Ultrasound examinations included biparietal diameter (BPD), head circumference (HC) and abdominal circumference (AC), and femur length (FL). Measures were assessed using the new international fetal growth standards (INTERGROWTH-21st Project). Generalised linear mixed logit regression models were used to examine the association between ultrasound measures and SGA at birth. RESULTS Overall fetal growth restriction began in early pregnancy and continued through delivery, but the timing of growth faltering varied by measure: it began by 20 weeks for HC, BPD and AC, earlier as compared to FL growth that started >30 weeks. SGA infants had significantly lower mean fetal growth parameters as early as 14 weeks. Ultrasound measures below the 10th percentile were associated with a two to four times higher risk of SGA at birth compared to fetuses greater than the 50th percentile, with the largest odds ratios for AC (OR 3.9, 95% confidence interval (CI) 2.7, 5.7). CONCLUSIONS Fetal growth faltering by ultrasound begins in early gestation among rural Vietnamese populations; these patterns clearly identified those to be born SGA. Efforts to prevent fetal growth faltering must begin early in pregnancy and perhaps even before pregnancy.
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Affiliation(s)
- Phuong Hong Nguyen
- Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam.,International Food Policy Research Institute, Hanoi, Vietnam
| | - O Yaw Addo
- Hubert Department of Global Health, Emory University, Atlanta, GA
| | - Melissa Young
- Hubert Department of Global Health, Emory University, Atlanta, GA
| | | | - Hoa Pham
- Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam
| | - Truong V Truong
- Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam
| | - Son Nguyen
- Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam
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Carvalho MA, Bernardes LS, Hettfleisch K, Pastro LDM, Vieira SE, Saldiva SRDM, Saldiva PHN, Francisco RPV. Associations of maternal personal exposure to air pollution on fetal weight and fetoplacental Doppler: A prospective cohort study. Reprod Toxicol 2016; 62:9-17. [PMID: 27103540 DOI: 10.1016/j.reprotox.2016.04.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 03/20/2016] [Accepted: 04/15/2016] [Indexed: 12/21/2022]
Abstract
We determined the influence of maternal air pollution exposure during each trimester of pregnancy on fetal and birth weight and fetoplacental hemodynamics. In total, 366 women with singleton pregnancies were prospectively followed in the city of São Paulo, Brazil. Nitrogen dioxide (NO2) and ozone (O3) were measured during each trimester using passive personal samplers. We evaluated fetal weight and Doppler velocimetry data from the umbilical, middle cerebral, and uterine arteries in the 3rd trimester, and birth weight. Multivariate analysis was performed, controlling for known determinants of fetal weight. Exposure to higher levels of O3 during the 2nd trimester was associated with higher umbilical artery pulsatility indices (PIs) [p=0.013; beta=0.017: standard error (SE)=0.007]. Exposure to higher levels of O3 during the 3rd trimester was associated with lower umbilical artery PIs (p=0.011; beta=-0.021; SE=0.008). Our results suggest that in the environment of São Paulo, O3 may affects placental vascular resistance.
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Affiliation(s)
- Mariana A Carvalho
- Procriar Study Group, São Paulo University, São Paulo, Brazil; Department of Obstetrics and Gynecology, São Paulo University School of Medicine, Brazil
| | - Lisandra S Bernardes
- Procriar Study Group, São Paulo University, São Paulo, Brazil; Department of Obstetrics and Gynecology, São Paulo University School of Medicine, Brazil.
| | - Karen Hettfleisch
- Procriar Study Group, São Paulo University, São Paulo, Brazil; Department of Obstetrics and Gynecology, São Paulo University School of Medicine, Brazil
| | - Luciana D M Pastro
- Procriar Study Group, São Paulo University, São Paulo, Brazil; Department of Obstetrics and Gynecology, São Paulo University School of Medicine, Brazil
| | - Sandra E Vieira
- Procriar Study Group, São Paulo University, São Paulo, Brazil; Department of Paediatric, São Paulo University School of Medicine, Brazil
| | - Silvia R D M Saldiva
- Procriar Study Group, São Paulo University, São Paulo, Brazil; Health Institute, State Health Secretariat, São Paulo, Brazil
| | - Paulo H N Saldiva
- Procriar Study Group, São Paulo University, São Paulo, Brazil; Institute of Advanced Studies of the University of São Paulo, São Paulo University, School of Medicine, Brazil
| | - Rossana P V Francisco
- Procriar Study Group, São Paulo University, São Paulo, Brazil; Department of Obstetrics and Gynecology, São Paulo University School of Medicine, Brazil
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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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23
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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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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: 19] [Impact Index Per Article: 2.1] [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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26
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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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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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Griffin M, Seed PT, Webster L, Myers J, MacKillop L, Simpson N, Anumba D, Khalil A, Denbow M, Sau A, Hinshaw K, von Dadelszen P, Benton S, Girling J, Redman CWG, Chappell LC, Shennan AH. Diagnostic accuracy of placental growth factor and ultrasound parameters to predict the small-for-gestational-age infant in women presenting with reduced symphysis-fundus height. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:182-190. [PMID: 25826778 PMCID: PMC4744762 DOI: 10.1002/uog.14860] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 03/25/2015] [Accepted: 03/25/2015] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To assess the diagnostic accuracy of placental growth factor (PlGF) and ultrasound parameters to predict delivery of a small-for-gestational-age (SGA) infant in women presenting with reduced symphysis-fundus height (SFH). METHODS This was a multicenter prospective observational study recruiting 601 women with a singleton pregnancy and reduced SFH between 24 and 37 weeks' gestation across 11 sites in the UK and Canada. Plasma PlGF concentration < 5(th) centile, estimated fetal weight (EFW) < 10(th) centile, umbilical artery Doppler pulsatility index > 95(th) centile and oligohydramnios (amniotic fluid index < 5 cm) were compared as predictors for a SGA infant < 3(rd) customized birth-weight centile and adverse perinatal outcome. Test performance statistics were calculated for all parameters in isolation and in combination. RESULTS Of the 601 women recruited, 592 were analyzed. For predicting delivery of SGA < 3(rd) centile (n = 78), EFW < 10(th) centile had 58% sensitivity (95% CI, 46-69%) and 93% negative predictive value (NPV) (95% CI, 90-95%), PlGF had 37% sensitivity (95% CI, 27-49%) and 90% NPV (95% CI, 87-93%); in combination, PlGF and EFW < 10(th) centile had 69% sensitivity (95% CI, 55-81%) and 93% NPV (95% CI, 89-96%). The equivalent receiver-operating characteristics (ROC) curve areas were 0.79 (95% CI, 0.74-0.84) for EFW < 10(th) centile, 0.70 (95% CI, 0.63-0.77) for low PlGF and 0.82 (95% CI, 0.77-0.86) in combination. CONCLUSIONS For women presenting with reduced SFH, ultrasound parameters had modest test performance for predicting delivery of SGA < 3(rd) centile. PlGF performed no better than EFW < 10(th) centile in determining delivery of a SGA infant.
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Affiliation(s)
- M. Griffin
- Women's Health Academic CentreKing's College LondonLondonUK
| | - P. T. Seed
- Women's Health Academic CentreKing's College LondonLondonUK
| | - L. Webster
- Women's Health Academic CentreKing's College LondonLondonUK
| | - J. Myers
- Maternal and Fetal Health Research Centre, Manchester Academic Health Science CentreUniversity of ManchesterManchesterUK
| | | | - N. Simpson
- Section of Obstetrics & Gynaecology, Institute of Biochemical & Clinical SciencesUniversity of LeedsLeedsUK
| | - D. Anumba
- Academic Unit of Reproductive and Developmental MedicineUniversity of SheffieldSheffieldUK
| | - A. Khalil
- St George's Hospital Medical SchoolUniversity of LondonLondonUK
| | | | - A. Sau
- University HospitalLewishamLondonUK
| | | | - P. von Dadelszen
- Department of Obstetrics and GynaecologyUniversity of British ColumbiaVancouverCanada
| | - S. Benton
- Department of Obstetrics and GynaecologyUniversity of British ColumbiaVancouverCanada
| | - J. Girling
- West Middlesex University HospitalIsleworthMiddlesexUK
| | - C. W. G. Redman
- Nuffield Department of Obstetrics and GynaecologyUniversity of OxfordOxfordUK
| | - L. C. Chappell
- Women's Health Academic CentreKing's College LondonLondonUK
| | - A. H. Shennan
- Women's Health Academic CentreKing's College LondonLondonUK
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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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Xu Y, Lek N, Cheung YB, Biswas A, Su LL, Kwek KYC, Yeo GSH, Soh SE, Saw SM, Gluckman PD, Chong YS. Unconditional and conditional standards for fetal abdominal circumference and estimated fetal weight in an ethnic Chinese population: a birth cohort study. BMC Pregnancy Childbirth 2015; 15:141. [PMID: 26108619 PMCID: PMC4480986 DOI: 10.1186/s12884-015-0569-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 05/27/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Diagnosis of intrauterine fetal growth restriction and prediction of small-for-gestation age are often based on fetal abdominal circumference or estimated fetal weight (EFW). The present study aims to create unconditional (cross-sectional) and conditional (longitudinal) standards of fetal abdominal circumference and EFW for use in an ethnic Chinese population. METHODS In the Growing Up in Singapore Towards healthy Outcome (GUSTO) birth cohort study in Singapore, fetal biometric measurements were obtained at enrolment to antenatal care (11-12 weeks) and up to three more time points during pregnancy. Singleton pregnancies with a healthy profile defined by maternal, pregnancy and fetal characteristics and birth outcomes were selected for this analysis. The Hadlock algorithm was used to calculate EFW. Mixed effects model was used to establish unconditional and conditional standards in z-scores and percentiles for both genders pooled and for each gender separately. RESULTS A total of 313 women were included, of whom 294 had 3 and 19 had 2 ultrasound scans other than the gestational age dating scan. Fetal abdominal circumference showed a roughly linear trajectory from 18 to 36 weeks of gestation, while EFW showed an accelerating trajectory. Gender differences were more pronounced in the 10(th) percentile than the 50(th) or 90(th) percentiles. As compared to other published charts, this population showed growth trajectories that started low but caught up at later gestations. CONCLUSIONS Unconditional and conditional standards for monitoring fetal size and fetal growth in terms of abdominal circumference and EFW are available for this ethnic-Chinese population. Electronic spreadsheets are provided for their implementation.
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Affiliation(s)
- Ying Xu
- Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore.
| | - Ngee Lek
- Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore.
- Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore.
| | - Yin Bun Cheung
- Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore.
- Department of International Health, University of Tampere, Tampere, Finland.
| | - Arijit Biswas
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.
| | - Lin Lin Su
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.
| | - Kenneth Y C Kwek
- Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore.
| | - George S H Yeo
- Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore.
| | - Shu-E Soh
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.
- Saw Swee Hock School of Public Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Seang-Mei Saw
- Saw Swee Hock School of Public Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore.
- Liggins Institute, University of Auckland, Auckland, New Zealand.
| | - Yap-Seng Chong
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore.
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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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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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The relationship between frequency of obstetric ultrasound scans and birthplace preference – A case control study. Midwifery 2015; 31:31-6. [DOI: 10.1016/j.midw.2014.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 04/07/2014] [Accepted: 05/04/2014] [Indexed: 11/24/2022]
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34
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Xie C, Wen X, Niu Z, Ding P, Liu T, He Y, Lin J, Yuan S, Guo X, Jia D, Chen W. Comparison of secondhand smoke exposure measures during pregnancy in the development of a clinical prediction model for small-for-gestational-age among non-smoking Chinese pregnant women. Tob Control 2014; 24:e179-87. [PMID: 25052864 DOI: 10.1136/tobaccocontrol-2014-051569] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 06/25/2014] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To compare predictive values of small-for-gestational-age (SGA) by different measures for secondhand smoke (SHS) exposure during pregnancy and to develop and validate a prediction model for SGA using SHS exposure along with sociodemographic and pregnancy factors. METHODS We compared the predictability of different measures of SHS exposure during pregnancy for SGA among 545 Chinese pregnant women, and then used the optimal SHS measure along with other clinically available factors to develop and validate a prediction model for SGA. We fit logistic regression models to predict SGA by single measures of SHS exposure (self-report, serum cotinine and CYP2A6*4) and different combinations (self-report+cotinine, cotinine+CYP2A6*4, self-report+CYP2A6*4 and self-report+cotinine+CYP2A6*4). RESULTS We found that self-reported SHS exposure alone predicted SGA (area under the receiver operating characteristic curve or area under the receiver operating curve (AUROC), 0.578) better than the other two single measures (cotinine, 0.547; CYP2A6*4, 0.529) or as accurately as combined SHS measures (0.545-0.584). The final prediction model that contained self-reported SHS exposure, prepregnancy body mass index, gestational weight gain velocity during the second and third trimesters, gestational diabetes, gestational hypertension and the third-trimester biparietal diameter Z-score could predict SGA fairly accurately (AUROC, 0.698). CONCLUSIONS Self-reported SHS exposure at peribirth performs better in predicting SGA than a single measure of serum cotinine at the same time, although repeated biochemical cotinine assessments throughout pregnancy may be optimal. Our simple prediction model is fairly accurate and can be potentially used in routine prenatal care.
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Affiliation(s)
- Chuanbo Xie
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Xiaozhong Wen
- Division of Behavioural Medicine, Department of Pediatrics, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Zhongzheng Niu
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Peng Ding
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Tao Liu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Yanhui He
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Jianmiao Lin
- Shenzhen Women and Children's Hospital, Shenzhen, China
| | - Shixin Yuan
- Shenzhen Women and Children's Hospital, Shenzhen, China
| | - Xiaoling Guo
- Foshan Women and Children's Hospital, Foshan, China
| | - Deqin Jia
- Foshan Women and Children's Hospital, Foshan, China
| | - Weiqing Chen
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, China
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Papastefanou I, Kappou D, Souka AP, Pilalis A, Chrelias C, Siristatidis C, Kassanos D. Reproducibility study of fetal 3-D volumetry in the first trimester: effect of fetal size and rotational angle of VOCAL software. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:877-883. [PMID: 24412167 DOI: 10.1016/j.ultrasmedbio.2013.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 11/06/2013] [Accepted: 11/11/2013] [Indexed: 06/03/2023]
Abstract
Intra- and inter-observer reproducibility of fetal volume measurement by 3-D ultrasound scan (using VOCAL [Virtual Organ Computer-Aided Analysis] software) in 27 fetuses at 7 to 13 wk was studied. For intra-observer variability, the mean difference (MD) and 95% limits of agreement (95% LOA) at 12°, 18° and 30° were MD(12) = 0.097, 95% LOA(12) = -0.87 to +1.06; MD(18) = 0.07, 95% LOA(18) = -1.31 to +1.45; and MD(30) = -0.07, 95% LOA(30) = -1.55 to +1.41. The standard deviation of the differences (SD(DIF)) increased with crown-rump length at 12° (p = 0.0016), 18° (p = 0.0011) and 30° (p = 0.02). For inter-observer variability, MD(12) = 0.15, 95% LOA(12) = -1.65 to +1.95; MD(18) = 0.042, 95% LOA(18) = -1.79 to +1.87; and MD(30) = 0.19, 95% LOA(30) = -1.24 to +1.62. SDDIF increased with crown-rump length at 18° (p = 0.0084) and 30° (p = 0.0073). The accuracy of fetal volume measurement was not influenced by rotational angle or fetal size. Precision deteriorated for wider rotational angles and larger fetuses.
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Affiliation(s)
- Ioannis Papastefanou
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology, University of Athens, Attikon University Hospital, Athens, Greece.
| | - Dimitra Kappou
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology, University of Athens, Attikon University Hospital, Athens, Greece
| | - Athena P Souka
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology, University of Athens, Attikon University Hospital, Athens, Greece
| | - Athanasios Pilalis
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology, University of Athens, Attikon University Hospital, Athens, Greece
| | - Charalambos Chrelias
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology, University of Athens, Attikon University Hospital, Athens, Greece
| | - Charalambos Siristatidis
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology, University of Athens, Attikon University Hospital, Athens, Greece
| | - Dimitrios Kassanos
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology, University of Athens, Attikon University Hospital, Athens, Greece
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Papastefanou I, Pilalis A, Chrelias C, Kassanos D, Souka AP. Screening for birth weight deviations by second and third trimester ultrasound scan. Prenat Diagn 2014; 34:759-64. [DOI: 10.1002/pd.4361] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 03/18/2014] [Accepted: 03/18/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Ioannis Papastefanou
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology; University of Athens, ‘Attikon’ University Hospital; Athens Greece
| | - Athanasios Pilalis
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology; University of Athens, ‘Attikon’ University Hospital; Athens Greece
| | - Charalampos Chrelias
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology; University of Athens, ‘Attikon’ University Hospital; Athens Greece
| | - Dimitrios Kassanos
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology; University of Athens, ‘Attikon’ University Hospital; Athens Greece
| | - Athena P. Souka
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology; University of Athens, ‘Attikon’ University Hospital; Athens Greece
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Crovetto F, Crispi F, Scazzocchio E, Mercade I, Meler E, Figueras F, Gratacos E. First-trimester screening for early and late small-for-gestational-age neonates using maternal serum biochemistry, blood pressure and uterine artery Doppler. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:34-40. [PMID: 23754253 DOI: 10.1002/uog.12537] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 05/06/2013] [Accepted: 05/29/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To assess the effectiveness of first-trimester screening for early and late small-for-gestational-age (SGA) neonates using maternal serum biochemistry, blood pressure and uterine artery Doppler. METHODS This was a prospective study of 4970 women with a singleton pregnancy who underwent routine first-trimester screening between 2009 and 2011. A logistic regression-based predictive model for SGA, defined as birth weight < 10(th) percentile, divided into early- or late-onset based on gestational age at delivery before or after 34 weeks' gestation, was constructed. The model included maternal baseline characteristics: serum levels of pregnancy-associated plasma protein-A and free β-human chorionic gonadotropin at 8-12 weeks and blood pressure and uterine artery Doppler at 11 + 0 to 13 + 6 weeks. RESULTS The prevalence of early and late SGA was 0.6% and 7.9%, respectively. Association with pre-eclampsia was 67% and 8%, respectively. At a false-positive rate of 15%, the detection rate for early SGA was 73%; however it differed substantially for cases with and without pre-eclampsia (90% vs 40%). For late SGA, at false-positive rates of 15 and 50%, detection rates were 32% and 70%, respectively, and did not substantially differ between cases with and without pre-eclampsia. CONCLUSIONS First-trimester screening predicts early SGA mainly because of its strong association with pre-eclampsia. Although prediction of late SGA was poorer, at a high false-positive rate it might be considered as part of a first-trimester strategy to select women requiring ultrasound assessment in the third trimester.
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Affiliation(s)
- F Crovetto
- Maternal-Fetal Medicine Department, ICGON, Hospital Clínic, Universitat de Barcelona; Fetal and Perinatal Medicine Research Group, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS); and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain; Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Dipartimento Ostetricia e Ginecologia, Univerisità degli Studi di Milano, Milan, Italy
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Shwarzman P, Waintraub AY, Frieger M, Bashiri A, Mazor M, Hershkovitz R. Third-trimester abnormal uterine artery Doppler findings are associated with adverse pregnancy outcomes. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:2107-2113. [PMID: 24277892 DOI: 10.7863/ultra.32.12.2107] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To evaluate the association between third-trimester abnormal uterine artery Doppler findings and pregnancy outcomes. METHODS A prospective study was designed, including 198 consecutive singleton pregnancies between 27 and 41 weeks' gestation. In the study population, 144 had normal uterine artery Doppler waveforms, 37 had unilateral pathologic waveforms, and 17 had bilateral pathologic waveforms. Eighty patients had intrauterine growth restriction (IUGR), preeclampsia toxemia, or both, and 118 had no complications and served as a control group. The uterine artery Doppler waveform was considered abnormal when a notch or pulsatility index above the 90th percentile was noted. RESULTS In patients with bilateral pathologic uterine artery Doppler waveforms, the rates of cesarean delivery, small-for-gestational-age (SGA) neonates, preterm delivery, and low Apgar scores were increased compared to patients with normal or pathologic unilateral waveforms (P = .009; P > .001; P = .007; P > .001, respectively). The incidence rates for SGA neonates, cesarean delivery, and preterm delivery were significantly higher among patients without IUGR or preeclampsia toxemia when associated with pathologic bilateral waveforms in comparison to normal waveforms (P = .01 for all). A bilateral pathologic waveform was found to be an independent risk factor for cesarean delivery and SGA neonates. The incidence rates for SGA neonates and preterm delivery were significantly higher among patients with IUGR and/or preeclampsia toxemia when associated with bilateral abnormalities in comparison to normal waveforms (P = .01 for both). CONCLUSIONS Third-trimester abnormal uterine artery Doppler findings are associated with worse perinatal outcomes among patients both with and without pregnancy complications.
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Affiliation(s)
- Polina Shwarzman
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, PO Box 151, 84101 Be'er Sheva, Israel.
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Grangé G. Modalités de dépistage et de diagnostic du fœtus petit pour l’âge gestationnel. ACTA ACUST UNITED AC 2013; 42:921-8. [DOI: 10.1016/j.jgyn.2013.09.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hawkins LK, Schnettler WT, Modest AM, Hacker MR, Rodriguez D. Association of third-trimester abdominal circumference with provider-initiated preterm delivery. J Matern Fetal Neonatal Med 2013; 27:1228-31. [PMID: 24102316 DOI: 10.3109/14767058.2013.852171] [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: 11/13/2022]
Abstract
OBJECTIVE Evaluate the association of a small third-trimester abdominal circumference (AC < 10th percentile) in the setting of a normal estimated fetal weight (EFW ≥ 10th percentile) with gestational age at delivery, indication for delivery and neonatal outcomes. METHODS Retrospective cohort study at an academic hospital of women with singleton pregnancy seen for ultrasound from 28+0-33+6 weeks of gestation during 2009-2011. Outcomes were compared between two groups: normal AC (AC and EFW ≥ 10th percentile) and small AC (AC < 10th percentile and EFW ≥ 10th percentile). RESULTS Among 592 pregnancies, fetuses in the small AC group (n = 55) experienced a higher incidence of overall preterm delivery (RR: 2.2, 95% CI: 1.3-3.7) and provider-initiated preterm delivery (RR: 3.7, CI: 1.8-7.5) compared to those in the normal AC group (n = 537). Neonates in the small AC group had a lower median birth weight whether delivered at term (p < 0.001) or preterm (p = 0.04), but were not more likely to experience intensive care unit admission or respiratory distress syndrome (all p ≥ 0.35). CONCLUSIONS Small AC, even in the setting of an EFW ≥ 10th percentile, was associated with a higher incidence of overall and provider-initiated preterm delivery despite similar neonatal outcomes. Further investigation is warranted to determine whether these preterm deliveries could be prevented.
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Affiliation(s)
- Leah K Hawkins
- Department of Obstetrics and Gynecology, Northwestern University , Chicago, IL , USA
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Souka AP, Papastefanou I, Michalitsi V, Pilalis A, Kassanos D. Specific formulas improve the estimation of fetal weight by ultrasound scan. J Matern Fetal Neonatal Med 2013; 27:737-42. [PMID: 23981185 DOI: 10.3109/14767058.2013.837877] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To develop and evaluate local, sex specific, small for gestational age (SGA) specific, large for gestational age (LGA) specific and combined (biometry, sex and Doppler indices) formulas for ultrasound estimated fetal weight (EFW). METHOD Low-risk singleton pregnancies that delivered within 7 days from ultrasound examination were assessed. A formula-generating group (1407 pregnancies) and a validation group (469 pregnancies) were created. Fractional regression analysis was used to develop the formulas. Systematic error, random error, fraction within the 10% of actual birth weight and Bland-Altman analysis were used. RESULTS The local formula and the Hadlock formula with local co-efficients performed better than the Hadlock formula. The SGA-specific formula, the LGA-specific formula and the combined formula had the lower systematic error (MSE: +0.0022291, -0.4226888, +0.8386222, respectively) and the narrower 95% LOA (-292.8 to +292.23, -485.6 to +461.5, -425.7 to +450.46, respectively). The SGA- and the LGA-specific formulas had higher fraction within the 10% of actual birth weight (81.5% and 84%, respectively). CONCLUSIONS Local formulas improve the EFW calculation. The combined formula can further optimize the accuracy and precision. Application of specific formulas for the small and the large fetus had the most pronounced effect in improving fetal weight estimation.
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Affiliation(s)
- Athena P Souka
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology, University of Athens, Attikon University Hospital , Athens , Greece and
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Souka AP, Papastefanou I, Pilalis A, Michalitsi V, Panagopoulos P, Kassanos D. Performance of the ultrasound examination in the early and late third trimester for the prediction of birth weight deviations. Prenat Diagn 2013; 33:915-20. [DOI: 10.1002/pd.4161] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 04/19/2013] [Accepted: 05/18/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Athena P. Souka
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology; University of Athens, ‘Attikon’ University Hospital; Athens Greece
- Fetal Medicine Unit, Leto Maternity Hospital; Athens Greece
| | - Ioannis Papastefanou
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology; University of Athens, ‘Attikon’ University Hospital; Athens Greece
| | - Athanasios Pilalis
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology; University of Athens, ‘Attikon’ University Hospital; Athens Greece
- Fetal Medicine Unit, Leto Maternity Hospital; Athens Greece
| | - Vasiliki Michalitsi
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology; University of Athens, ‘Attikon’ University Hospital; Athens Greece
| | - Perikles Panagopoulos
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology; University of Athens, ‘Attikon’ University Hospital; Athens Greece
| | - Dimitrios Kassanos
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology; University of Athens, ‘Attikon’ University Hospital; Athens Greece
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Souka AP, Pilalis A, Papastefanou I, Salamalekis G, Kassanos D. Reproducibility study of crown-rump length and biparietal diameter measurements in the first trimester. Prenat Diagn 2012; 32:1158-65. [DOI: 10.1002/pd.3976] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Athena P. Souka
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology, University of Athens; Attikon' University Hospital; Athens Greece
| | - Athanasios Pilalis
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology, University of Athens; Attikon' University Hospital; Athens Greece
| | - Ioannis Papastefanou
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology, University of Athens; Attikon' University Hospital; Athens Greece
| | - George Salamalekis
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology, University of Athens; Attikon' University Hospital; Athens Greece
| | - Dimitrios Kassanos
- Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology, University of Athens; Attikon' University Hospital; Athens Greece
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Morales-Roselló J, Peralta-Llorens N. Doppler study of the fetal vertebral artery in small for gestational age fetuses with intrauterine growth restriction. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:1003-1010. [PMID: 22733849 DOI: 10.7863/jum.2012.31.7.1003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The purposes of this study were to evaluate the Doppler resistive index of the fetal vertebral artery in small for gestational age (SGA) fetuses and to examine the ability of the vertebral artery resistive index in the diagnosis of intrauterine growth restriction (IUGR). METHODS A total of 437 Doppler examinations of the vertebral and umbilical artery resistive indices were performed in 437 fetuses between 26 and 41 weeks' gestation. According to birth weight, fetuses were classified into 5 groups: 1, above the 10th percentile; 2, between the 10th and 5th percentiles; 3, between the 5th and 3rd percentiles; 4, below the 3rd percentile; and 5, below the 3rd percentile with an umbilical artery resistive index above the 95th percentile. Subsequently, vertebral artery resistive index values were converted into multiples of the median, and box and whisker charts were generated to evaluate differences. Finally, receiver operating characteristic curves were calculated to assess the accuracy of the vertebral artery resistive index for predicting IUGR and a low Apgar score. RESULTS Compared to normally grown fetuses, vertebral artery resistive index values were lower in fetuses with birth weight below the 3rd percentile, and this difference was greater in fetuses with birth weight below the 3rd percentile and Doppler anomalies of the umbilical artery. The receiver operating characteristic analysis showed that the vertebral artery resistive index diagnosed SGA fetuses and low Apgar scores poorly. However, it performed better in cases of severe IUGR with high umbilical artery resistive index values. CONCLUSIONS Preliminary data show that the vertebral artery resistive index diminishes in growth-restricted SGA fetuses. Doppler examination of the vertebral artery seems to identify a group of fetuses with brain sparing and severe IUGR.
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