1
|
Ramos SZ, Has P, Gimovsky AC, Danilack VA, Savitz DA, Lewkowitz AK. Outcomes among Neonates after a Diagnosis of Persistent or Transient Fetal Growth Restriction Delivered at Term. Am J Perinatol 2024; 41:e1470-e1477. [PMID: 36894159 PMCID: PMC10562520 DOI: 10.1055/a-2051-3859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
OBJECTIVE This study aimed to evaluate whether transient fetal growth restriction (FGR) that resolves prior to delivery confers a similar risk of neonatal morbidity as uncomplicated FGR that persists at term. STUDY DESIGN This is a secondary analysis of a medical record abstraction study of singleton live-born pregnancies delivered at a tertiary care center between 2002 and 2013. Patients with fetuses that had either persistent or transient FGR and delivered at 38 weeks or later were included. Patients with abnormal umbilical artery Doppler studies were excluded. Persistent FGR was defined as estimated fetal weight (EFW) <10th percentile by gestational age from diagnosis through delivery. Transient FGR was defined as EFW <10th percentile on at least one ultrasound, but not on the last ultrasound prior to delivery. The primary outcome was a composite of neonatal morbidity: neonatal intensive care unit admission, Apgar's score <7 at 5 minutes, neonatal resuscitation, arterial cord pH <7.1, respiratory distress syndrome, transient tachypnea of the newborn, hypoglycemia, sepsis, or death. Baseline characteristics and obstetric and neonatal outcomes were compared using Wilcoxon's rank-sum and Fisher's exact test. Log binomial regression was used to adjust for confounders. RESULTS Of 777 patients studied, 686 (88%) had persistent FGR and 91 (12%) had transient FGR. Patients with transient FGR were more likely to have a higher body mass index, gestational diabetes, diagnosed with FGR earlier in pregnancy, have spontaneous labor, and deliver at later gestational ages. There was no difference in the composite neonatal outcome (relative risk = 1.03, 95% confidence interval [CI] 0.72, 1.47) for transient versus persistent FGR after adjusting for confounders (adjusted relative risk = 0.79, 95% CI 0.54, 1.17). There were no differences in cesarean delivery or delivery complications between groups. CONCLUSION Neonates born at term after transient FGR do not appear to have differences in composite morbidity compared with those where uncomplicated FGR persists at term. KEY POINTS · No differences in neonatal outcomes in uncomplicated persistent versus transient FGR at term.. · Transient FGR pregnancies more likely to deliver at later gestational ages.. · No differences in mode of delivery or obstetric complications in persistent versus transient FGR at term..
Collapse
Affiliation(s)
- Sebastian Z. Ramos
- Department of Obstetrics and Gynecology, Women & Infants Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Phinnara Has
- Lifespan Biostatistics, Epidemiology, and Research Design (BERD), Rhode Island Hospital, Lifespan Healthcare System, Providence, Rhode Island
| | - Alexis C. Gimovsky
- Department of Obstetrics and Gynecology, Women & Infants Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Valery A. Danilack
- Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, Connecticut
| | - David A. Savitz
- Department of Obstetrics and Gynecology, Women & Infants Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Adam K. Lewkowitz
- Department of Obstetrics and Gynecology, Women & Infants Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| |
Collapse
|
2
|
Sabir MS, Hassan MM, Malik M, Saleem R, Tariq Z, Zohaib K, Javaid M, Malik AY, Saleem A. Diagnostic Accuracy of Fetal Anterior Abdominal Wall Thickness as an Early Sonographic Sign for Diagnosing Gestational Diabetes. Cureus 2023; 15:e46538. [PMID: 37927742 PMCID: PMC10625453 DOI: 10.7759/cureus.46538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Traditionally, different fetal variable measurements are used in ultrasound to assess fetal growth. Ultrasound can detect abnormal fetal growth. Gestational diabetes mellitus (GDM) is linked to higher fetal obesity as early as 20 weeks of pregnancy. The amount of fetal adipose tissue may be measured by measuring the thickness of the anterior abdominal wall. Measuring the thickness of the fetus's anterior abdominal wall (AAWT) is a straightforward procedure that may be performed alongside standard abdominal circumference measurements. Objectives To check the diagnostic accuracy of fetal AAWT as an early sonographic sign for diagnosing GDM, keeping oral glucose tolerance test as the gold standard. Study design This research was conducted using a cross-sectional analysis. Study place and duration The study was conducted in the Radiology Department at Rawalpindi Medical University and Allied Hospitals from July 10, 2019 to January 9, 2020. Materials and methods Women between the ages of 18 and 45 who had a family history of type 2 diabetes and were at risk for developing GDM were recruited. Exclusions were made for diabetic women, those carrying multiples, and those with autoimmune diseases. The AAWT measurement of the fetus, which included the skin and subcutaneous tissue, was acquired using the traditional anterior cranial view, 2-3 cm lateral to cord insertion. Pregnant patients at risk for GDM underwent screening using an oral glucose tolerance test. Those exhibiting any two abnormal values were diagnosed with GDM. Results The overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of fetal AAWT as an early sonographic sign for diagnosing GDM, with the oral glucose tolerance test as the gold standard, were 93.14%, 82.65%, 84.82%, 92.05%, and 88.0%, respectively. Conclusion The study concludes that the diagnostic accuracy of fetal AAWT as an early sonographic indicator for identifying gestational diabetes is notably high.
Collapse
Affiliation(s)
| | | | - Moeena Malik
- Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | - Rabia Saleem
- Obstetrics and Gynecology, Rawalpindi Medical University, Rawalpindi, PAK
| | - Zartasha Tariq
- General Medicine, Holy Family Hospital Rawalpindi, Rawalpindi, PAK
| | - Khurram Zohaib
- Internal Medicine, Benazir Bhutto Hospital, Rawalpindi, PAK
| | - Maham Javaid
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Adnan Younas Malik
- Internal Medicine and Nephrology, District Headquarter Hospital, Rawalpindi, PAK
| | - Amna Saleem
- Pediatrics and Child Health, Islamic International Medical College Trust (IIMCT)Pakistan Railways Hospital, Rawalpindi, PAK
| |
Collapse
|
3
|
Lesser HT, D'Adamo C, O'Reilly G, Arrabal P, Ehsanipoor RM. Diagnosis of mid-second trimester fetal growth restriction and associated outcomes. J Matern Fetal Neonatal Med 2022; 35:10168-10172. [PMID: 36100267 DOI: 10.1080/14767058.2022.2122042] [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: 10/14/2022]
Abstract
OBJECTIVE To evaluate maternal and neonatal outcomes of low-risk singleton pregnancies, without underlying maternal medical conditions or genetic and fetal anomalies associated with fetal growth restriction, that were diagnosed with fetal growth restriction (FGR) (EFW < 10th %) in the mid-second trimester (between 17 and 22 weeks and 6 days' gestation). METHODS A retrospective cohort study of all women who underwent a routine fetal anatomy ultrasound between 17 and 22 weeks and 6 days' gestation at a community-based academic hospital was performed to identify subjects with an EFW <10th%. Pregnancies with inadequate dating, multiple gestations, preexisting maternal vascular disease (chronic hypertension and pregestational diabetes), lethal fetal anomalies, and abnormal prenatal genetic screening were excluded. Descriptive statistics were computed to describe the study population. Subjects were stratified into two groups, estimated fetal weight (EFW) <5th% and EFW 5th-9th%. The primary outcome was a small for gestational age neonate (SGA) at delivery. Secondary outcomes included a composite adverse neonatal outcome, perinatal death, hypertensive disorders of pregnancy, medically indicated delivery, and mode of delivery. A comparison of the two groups, EFW <5th% and EFW 5th-9th %, was performed. Continuous variables were compared utilizing Wilcoxon Rank Sum tests and categorical variables were compared using Fisher's exact test or Chi-squared tests, and a dichotomous composite variable for adverse neonatal outcomes was also calculated. RESULTS In total, 3,868 unique patient records were screened. Thirty-two patient records (0.8% of the total screened records) were eligible for inclusion. The primary outcome, SGA at delivery, occurred in 13/32 (41%) of the subjects. The secondary outcomes of the composite neonatal morbidity occurred in 9/32 (28%), hypertensive disorders of pregnancy in 10/32 (31%), and medically indicated delivery at <28 weeks gestation in 7/32 (22%) of the subjects. When comparing EFW <5th% and EFW 5th-9th%, EFW <5th% had a larger percentage of SGA newborns (66% vs. 25%, p = .02, OR = 8.0 95% CI 1.5-42.5). EFW <5th% was also significantly associated with a greater composite adverse neonatal outcome when compared to EFW 5th-9th% (54% vs. 10%, p = .015). The subgroup with an EFW <5th% also had higher rates of adverse outcomes including preeclampsia (42% vs. 10%, p = .073), abnormal umbilical artery Doppler studies (50% vs. 15%, p = .049), and medically indicated delivery <28 weeks (42% vs. 10%, p = .07). CONCLUSIONS Early onset FGR is a associated with high rates of SGA at delivery, as well as several adverse maternal and neonatal outcomes which include hypertensive disorders of pregnancy, a greater composite neonatal morbidity, perinatal death, and medically indicated preterm delivery. EFW <5th% was associated with worse outcomes when compared to those with an EFW 5th%-9th%.
Collapse
Affiliation(s)
- Henry Tal Lesser
- Department of Obstetrics and Gynecology, Sinai Hospital, Baltimore, MD, USA
| | - Christopher D'Adamo
- bDepartment of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Geralyn O'Reilly
- Department of Obstetrics and Gynecology, Sinai Hospital, Baltimore, MD, USA
| | - Pedro Arrabal
- Department of Obstetrics and Gynecology, Sinai Hospital, Baltimore, MD, USA
| | | |
Collapse
|
4
|
Saw SN, Biswas A, Mattar CNZ, Lee HK, Yap CH. Machine learning improves early prediction of small-for-gestational-age births and reveals nuchal fold thickness as unexpected predictor. Prenat Diagn 2021; 41:505-516. [PMID: 33462877 DOI: 10.1002/pd.5903] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 01/05/2021] [Accepted: 01/10/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate the performance of the machine learning (ML) model in predicting small-for-gestational-age (SGA) at birth, using second-trimester data. METHODS Retrospective data of 347 patients, consisting of maternal demographics and ultrasound parameters collected between the 20th and 25th gestational weeks, were studied. ML models were applied to different combinations of the parameters to predict SGA and severe SGA at birth (defined as 10th and third centile birth weight). RESULTS Using second-trimester measurements, ML models achieved an accuracy of 70% and 73% in predicting SGA and severe SGA whereas clinical guidelines had accuracies of 64% and 48%. Uterine PI (Ut PI) was found to be an important predictor, corroborating with existing literature, but surprisingly, so was nuchal fold thickness (NF). Logistic regression showed that Ut PI and NF were significant predictors and statistical comparisons showed that these parameters were significantly different in disease. Further, including NF was found to improve ML model performance, and vice versa. CONCLUSION ML could potentially improve the prediction of SGA at birth from second-trimester measurements, and demonstrated reduced NF to be an important predictor. Early prediction of SGA allows closer clinical monitoring, which provides an opportunity to discover any underlying diseases associated with SGA.
Collapse
Affiliation(s)
- Shier Nee Saw
- Bioinformatics Institute, Agency for Science, Technology and Research (A*STAR), Singapore.,Department of Artificial Intelligence, Faculty of Computer Science and Information Technology, University of Malaya, Malaysia
| | - Arijit Biswas
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health Systems, Singapore
| | - Citra Nurfarah Zaini Mattar
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health Systems, Singapore
| | - Hwee Kuan Lee
- Bioinformatics Institute, Agency for Science, Technology and Research (A*STAR), Singapore.,Rehabilitation Research Institute of Singapore, Singapore.,School of Computing, National University of Singapore, Singapore.,Image and Pervasive Access Lab (IPAL), CNRS UMI, Singapore.,Singapore Eye Research Institute, Singapore
| | - Choon Hwai Yap
- Department of Bioengineering, Imperial College London, London, UK
| |
Collapse
|
5
|
Patel V, Resnick K, Liang C, Smith M, Haghpeykar HS, Mastrobattista JM, Gandhi M. Midtrimester Ultrasound Predictors of Small-for-Gestational-Age Neonates. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:2027-2031. [PMID: 32420664 DOI: 10.1002/jum.15310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/01/2020] [Accepted: 04/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To determine whether a specific estimated fetal weight (EFW) or abdominal circumference (AC) measurement percentile at the 18-to 24-week ultrasound (US) examination is associated with a small-for-gestational-age (SGA) neonate. METHODS A retrospective case-control study was conducted including women with uncomplicated singleton gestations who delivered a term SGA neonate identified as having a birth weight (BW) below the 10th percentile on the Olsen growth curve and had an 18- to 24-week US examination in our database. The study period was October 2011 to January 2018. A similar number of control charts were requested randomly over the same time with BW in the 10th to 90th percentiles, all which had an 18-to 24-week US examination in our database. After all neonates meeting BW criteria were identified, a chart review was performed to specifically evaluate biometric parameters from the US at 18 to 24 weeks to determine a potential correlation with the EFW percentile and AC percentile. Pregnancy, neonatal outcomes, and maternal demographic characteristics were collected. RESULTS A total of 549 term neonates with a BW below the 10th percentile, and 593 control term neonates with BW in the of 10th to 90th percentiles were reviewed. Our analyses revealed that the AC and EFW percentiles were poor predictors of BW (<10th percentile; areas under the receiver operating characteristic curves, 0.68 and 0.69, respectively). A similar low ability of AC and EFW to predict BW below the 5th percentile was noted. CONCLUSIONS (1) No tipping point or cutoff for the EFW or AC percentile at the 18- to 24-week US examination was identified to predict a term SGA neonate. (2) These data are helpful when counseling women in midgestation about specific parameters, their importance, and the potential need for follow up imaging.
Collapse
|
6
|
Bernardes TP, Mol BW, Ravelli ACJ, van den Berg P, Boezen HM, Groen H. Early and late onset pre-eclampsia and small for gestational age risk in subsequent pregnancies. PLoS One 2020; 15:e0230483. [PMID: 32218582 PMCID: PMC7100959 DOI: 10.1371/journal.pone.0230483] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 03/02/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pre-eclampsia shares pathophysiology with intrauterine growth restriction. OBJECTIVE To investigate whether delivery of a small for gestational age (SGA) infant in the 1st pregnancy increases the risk of early and late onset pre-eclampsia in the 2nd pregnancy. Conversely, we investigated whether pre-eclampsia in the 1st pregnancy impacts SGA risk in the 2nd pregnancy. STUDY DESIGN We studied a cohort from the Dutch Perinatal Registry of 265,031 women with 1st and 2nd singleton pregnancies who delivered between 2000 and 2007. We analyzed 2nd pregnancy risks of early and late onset pre-eclampsia-defined by delivery before or after 34 gestational weeks-as well as SGA below the 5th and between the 5th and 10th percentiles risks with multivariable logistic regressions. Interaction terms between 1st pregnancy hypertension, pre-eclampsia, SGA, and delivery before or after 34 gestational weeks were included in the regressions. RESULTS First pregnancy early onset pre-eclampsia increased risk of SGA <5th percentile (OR 2.1, 95% CI 1.7-2.7) in the 2nd pregnancy. Late onset pre-eclampsia increased the SGA <5th percentile marginally (OR 1.1, 95% CI 1.0-1.3). In the absence of 1st pregnancy hypertensive disorder, women who delivered an SGA infant in their 1st pregnancy were at increased risk of 2nd pregnancy late onset pre-eclampsia (SGA <5th: OR 2.05, 95% CI 1.58-2.66; SGA 5-10th: OR 1.39, 95% CI 1.01-1.93). Early onset 2nd pregnancy pre-eclampsia risk was also increased, but this was only statistically significant for women who delivered an SGA infant below the 5th percentile in the 1st pregnancy (SGA <5th: OR 2.44, 95% CI 1.19-5.00; SGA 5-10th: OR 1.69, 95% CI 0.68-4.24;). CONCLUSION Women with 1st pregnancy early onset pre-eclampsia have increased risk of SGA <5th percentile in the 2nd pregnancy. SGA in the 1st pregnancy increases pre-eclampsia risk in the 2nd pregnancy even in the absence of hypertensive disorders in the 1st pregnancy, although absolute risks remain low. These findings strengthen the evidence base associating intrauterine growth restriction with early onset pre-eclampsia.
Collapse
Affiliation(s)
| | - Ben W. Mol
- Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Anita C. J. Ravelli
- Medical Informatics/Obstetrics and Gynaecology, Amsterdam UMC, Amsterdam, Netherlands
| | - Paul van den Berg
- Obstetrics and Gynaecology, University Medical Center Groningen, Groningen, Netherlands
| | - H. Marike Boezen
- Epidemiology, University Medical Center Groningen, Groningen, Netherlands
| | - Henk Groen
- Epidemiology, University Medical Center Groningen, Groningen, Netherlands
| |
Collapse
|
7
|
Pels A, Beune IM, van Wassenaer-Leemhuis AG, Limpens J, Ganzevoort W. Early-onset fetal growth restriction: A systematic review on mortality and morbidity. Acta Obstet Gynecol Scand 2019; 99:153-166. [PMID: 31376293 PMCID: PMC7004054 DOI: 10.1111/aogs.13702] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/26/2019] [Accepted: 07/16/2019] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Severe early-onset fetal growth restriction is an obstetric condition with significant risks of perinatal mortality, major and minor neonatal morbidity, and long-term health sequelae. The prognosis of a fetus is influenced by the extent of prematurity and fetal weight. Clinical care is individually adjusted. In literature, survival rates vary and studies often only include live-born neonates with missing rates of antenatal death. This systematic review aims to summarize the literature on mortality and morbidity. MATERIAL AND METHODS A broad literature search was conducted in OVID MEDLINE from 2000 to 26 April 2019 to identify studies on fetal growth restriction and perinatal death. Studies were excluded when all included children were born before 2000 because (neonatal) health care has considerably improved since this period. Studies were included that described fetal growth restriction diagnosed before 32 weeks of gestation and antenatal mortality and neonatal mortality and/or morbidity as outcome. Quality of evidence was rated with the GRADE instrument. RESULTS Of the 2604 publications identified, 25 studies, reporting 2895 pregnancies, were included in the systematic review. Overall risk of bias in most studies was judged as low. The quality of evidence was generally rated as very low to moderate, except for 3 large well-designed randomized controlled trials. When combining all data on mortality, in 355 of 2895 pregnancies (12%) the fetus died antenatally, 192 died in the neonatal period (8% of live-born neonates) and 2347 (81% of all pregnancies) children survived. Of the neonatal morbidities recorded, respiratory distress syndrome (34% of the live-born neonates), retinopathy of prematurity (13%) and sepsis (30%) were most common. Of 476 children that underwent neurodevelopmental assessment, 58 (12% of surviving children, 9% of all pregnancies) suffered from cognitive impairment and/or cerebral palsy. CONCLUSIONS When combining the data of 25 included studies, survival in fetal growth restriction pregnancies, diagnosed before 32 weeks of gestation, was 81%. Neurodevelopmental impairment was assessed in a minority of surviving children. Individual prognostic counseling on the basis of these results is hampered by differences in patient and pregnancy characteristics within the included patient groups.
Collapse
Affiliation(s)
- Anouk Pels
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Irene M Beune
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Jacqueline Limpens
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wessel Ganzevoort
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
8
|
Doulaveris G, Gallagher P, Romney E, Richley M, Gebb J, Rosner M, Dar P. Fetal abdominal circumference in the second trimester and prediction of small for gestational age at birth. J Matern Fetal Neonatal Med 2019; 33:2415-2421. [PMID: 30482067 DOI: 10.1080/14767058.2018.1554039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Infants that are small for gestational age (SGA) at birth are at increased risk for morbidity and mortality. Unfortunately, the antenatal prediction of SGA is suboptimal.Objectives: We sought to: (1) examine the association between second trimester fetal abdominal circumference < 10% (2T-AClag) with SGA and other gestational and neonatal adverse outcomes; (2) assess 2T-AClag as a predictor of SGA.Study design: Retrospective study of 212 singleton gestations with 2T-AClag on routine ultrasound between 18-24 weeks. The study group was compared to 424 gestations without 2T-AClag for maternal characteristics as well as pregnancy and neonatal adverse outcomes. A multivariate logistic regression was used to determine the predictive value of 2T-AClag for SGA, adjusting for maternal and pregnancy characteristics. The screening model accuracy was assessed through receiver operating characteristic (ROC) curves. Fetal growth restriction (FGR) was defined as an estimated fetal weight (EFW) less than the 10th percentile.Results: Gestations with 2T-AClag had higher rates of SGA (35.7 versus 11.6%, p < .0001), FGR (17 versus 1.7%, p < .0001), pregnancy induced hypertension (31.1 versus 17%, p < .0001), preeclampsia (14.6 versus 7.8%, 0 = 0.01), abnormal umbilical artery Doppler (30 versus 5.1%, p < .0001), indicated preterm birth (5.7 versus 1.9%, p = .01), primary cesarean birth (29.6 versus 20.1%, p = .01) and NICU admission (12.9 versus 6.4%, p = .009). After adjusting for maternal and gestational risk factors, 2T-AClag remained an independent risk factor for SGA (OR 4.53, 95%CI 2.91-7.05, p < .0001) and FGR (OR 11.57, 95%CI 5.02-26.65, p < .0001). The inclusion of 2T-AClag in a regression model with traditional risk factors, significantly improved the model's predictability for SGA and FGR (area under ROC curve increased from 0.618 to 0.723 and 0.653 to 0.819, respectively, p < .0001).Conclusions: Second trimester abdominal circumference (AC) lag is associated with an increased risk of SGA, FGR and other adverse outcomes. The inclusion of 2T-AClag in a screening model for prediction of SGA and FGR may improve the identification of this at-risk group and assist in customizing surveillance plans.Brief rationaleScreening for newborns that are small for gestational age (SGA) at birth is currently suboptimal. Our study shows that second trimester abdominal circumference (AC) lag, using a parameter already routinely assessed during anatomic survey, is associated with SGA at birth and can improve current screening for growth restriction and other gestational, fetal and neonatal complications.
Collapse
Affiliation(s)
- Georgios Doulaveris
- Department of Obstetrics, Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Patience Gallagher
- Department of Obstetrics, Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Elizabeth Romney
- Department of Obstetrics, Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Michael Richley
- Department of Obstetrics, Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Juliana Gebb
- Department of Obstetrics, Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Mara Rosner
- Department of Obstetrics and Gynecology, NYU School of Medicine, New York, NY, USA
| | - Pe'er Dar
- Department of Obstetrics, Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| |
Collapse
|
9
|
Zhang-Rutledge K, Mack LM, Mastrobattista JM, Gandhi M. Significance and Outcomes of Fetal Growth Restriction Below the 5th Percentile Compared to the 5th to 10th Percentiles on Midgestation Growth Ultrasonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2243-2249. [PMID: 29476559 DOI: 10.1002/jum.14577] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 11/15/2017] [Accepted: 12/04/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To determine whether there are differences in neonatal and pregnancy outcomes in pregnancies complicated by severe fetal growth restriction, defined as estimated fetal weight below the 5th percentile, compared with estimated fetal weight in the 5th to 10th percentiles at midgestation. METHODS We conducted a retrospective review of singleton nonanomalous gestations with estimated fetal weight at or below the 10th percentile (Hadlock et al. Radiology 1991; 181:129-133) at 18 to 24 weeks' gestation. The cohort was divided into fetuses with estimated fetal weight below the 5th percentile and estimated fetal weight in the 5th to 10th percentiles. Antenatal and neonatal outcomes were compared across the groups. RESULTS Of the 254 growth-restricted fetuses, 91 had estimated fetal weight below the 5th percentile, and 163 were in the 5th to 10th percentiles. Fetuses below the 5th percentile were 2.82 times more likely to be born small for gestational age compared to fetuses at the 5th to 10th percentiles (P = .001). Fetuses with estimated fetal weight below the 5th percentile had higher rates of hypertensive disorders of pregnancy (relative risk [RR], 1.79; P = .04), abnormal umbilical artery Doppler waveforms (RR, 6.27; P = .01), labor induction (RR, 1.45; P = .002), neonatal intensive care unit admission (RR, 1.73; P = .02), and Apgar scores of less than 7 at 1 minute (RR, 2.05; P = .04). CONCLUSIONS Severely growth-restricted fetuses with an estimated fetal weight below the 5th percentile at 18 to 24 weeks are born smaller and have worse antepartum and neonatal outcomes than those with an estimated fetal weight in the 5th to 10th percentiles. These findings suggest that severely growth-restricted fetuses at midgestation should be treated and counseled differently than those in the 5th to 10th percentiles.
Collapse
Affiliation(s)
- Kathy Zhang-Rutledge
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Lauren M Mack
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Joan M Mastrobattista
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Manisha Gandhi
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
10
|
İlhan G, Gültekin H, Kubat A, Gokmen Karasu AF, Güngör ES, Zebitay GA, Verit Atmaca FF. Preliminary evaluation of foetal liver volume by three-dimensional ultrasound in women with gestational diabetes mellitus. J OBSTET GYNAECOL 2018; 38:922-926. [PMID: 29553838 DOI: 10.1080/01443615.2018.1434136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The aim of the study was to assess the standard foetal biometric measurements and foetal liver volume (FLV) in pregnancies complicated by gestational diabetes mellitus (GDM) at the time of GDM screening and to compare the results with foetuses in normal pregnancies. Ninety-seven pregnant women with normal singleton uncomplicated pregnancies between 24 and 28 weeks of gestation were allocated into GDM (+) (n: 33) and GDM (-) (n: 64) groups based on their 75 g oral glucose tolerance test results. Foetal biometric measurements and FLV measurements of the groups were compared. Although there were no significant differences in the standard biometric measurements between the two groups, FLV was significantly higher in the women with GDM (p < .01). The ROC analysis implied that with a cut-off value of FLV of 32.72 cm3 for GDM prediction, the sensitivity was 78.8% and specificity was 56.3%. We suggest that FLV measurements during the second-trimester ultrasound scanning may be a tool for the prediction of GDM in the obstetric population. Impact statement What is already known on this subject? GDM is an important pregnancy disease, because of its possible foetal and maternal complications. Besides the standard biometric measurements, some other foetal body dimensions such as the anterior abdominal wall thickness, skinfold thickness, adipose tissue thickness, Wharton's jelly thickness, foetal liver length and foetal liver volume (FLV) have been evaluated as ultrasound parameters of glycaemic control. While the evaluation of foetal liver dimensions has a role in identifying foetal growth acceleration, previous studies addressed patients with insulin-dependent diabetes mellitus rather than gestational diabetes mellitus, utilised two-dimensional ultrasound and did not argue the diagnostic value of these findings. What do the results of this study add? In our study, besides the standard biometric measurements, the FLV measurements were evaluated by a three-dimensional ultrasound. Although there were no significant differences in the standard biometric measurements between the GDM (+) and GDM (-) groups, the FLV was significantly higher in women with GDM. The FLV was found to be a potential predictive factor for GDM. The ROC analysis implied that as a cut-off value of FLV of 32.72 cm3 for GDM prediction, the sensitivity was 78.8% and the specificity was 56.3%. What are the implications of these findings for clinical practise and/or further research? Screening for GDM with oral glucose tolerance test within the limited weeks of gestation may not always be feasible. On the other hand, the mid-trimester ultrasound scanning is done almost in all pregnancies. Accordingly, FLV measurement might be an alternative method for the GDM diagnosis.
Collapse
Affiliation(s)
- Gülşah İlhan
- a Department of Obstetrics and Gynecology , Health Sciences University, Süleymaniye Women and Children's Health Training and Research Hospital , İstanbul , Turkey
| | - Hüseyin Gültekin
- a Department of Obstetrics and Gynecology , Health Sciences University, Süleymaniye Women and Children's Health Training and Research Hospital , İstanbul , Turkey
| | - Ayça Kubat
- a Department of Obstetrics and Gynecology , Health Sciences University, Süleymaniye Women and Children's Health Training and Research Hospital , İstanbul , Turkey
| | | | - Emre Sinan Güngör
- a Department of Obstetrics and Gynecology , Health Sciences University, Süleymaniye Women and Children's Health Training and Research Hospital , İstanbul , Turkey
| | - Galip Ali Zebitay
- a Department of Obstetrics and Gynecology , Health Sciences University, Süleymaniye Women and Children's Health Training and Research Hospital , İstanbul , Turkey
| | - Fatma Ferda Verit Atmaca
- a Department of Obstetrics and Gynecology , Health Sciences University, Süleymaniye Women and Children's Health Training and Research Hospital , İstanbul , Turkey
| |
Collapse
|
11
|
Balcı S. Predictive values of maternal serum PAPP-A level, uterine artery Doppler velocimetry, and fetal biometric measurements for poor pregnancy and poor neonatal outcomes in pregnant women. J Turk Ger Gynecol Assoc 2016; 17:143-9. [PMID: 27651722 DOI: 10.5152/jtgga.2016.16040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 07/21/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine predictive values of maternal serum PAPP-A (msPAPP-A) levels, uterine artery Doppler velocimetry, and fetal biometric measurements (FBMs) for poor pregnancy and poor neonatal outcomes. MATERIAL AND METHODS This prospective cohort study was conducted on singleton pregnancies followed until delivery. Pregnancy and neonatal outcomes were evaluated with respect to the msPAPP-A level at the 11(th)-14(th) weeks, uterine artery Doppler velocimetry at the 15(th)-18(th) weeks, and FBMs at the 20(th)-24(th) and 28(th)-32(nd) weeks of pregnancy. RESULTS One hundred fifty-eight women constituted the study group; 17 (10.75%) of them had at least one poor pregnancy outcome. The cut-off point of 0.72 multiple of the median (MoM) for the PAPP-A level achieved a sensitivity of 82.4% and a specificity of 29.8% for poor pregnancy outcomes. The mean birth weight was significantly lower in the subgroup with a higher mean pulsatility index of uterine arteries (UAPImean≥1.19) (p=0.025) as well as in the subgroup with a higher mean resistance index of uterine arteries (UARImean≥0.62) (p=0.013). When the subgroup of pregnant women under the risk of early-onset IUGR according to FBMs was compared to the low-risk group, statistically significant differences were seen in terms of pregnancy outcomes (p=0.045) and birth weight (p=0.011). CONCLUSION Maternal serum PAPP-A level and FBMs could be used for predicting pregnancy outcomes, while uterine artery Doppler velocimetry and FBMs could be used for predicting neonatal outcomes, specifically the birth weight.
Collapse
Affiliation(s)
- Serdar Balcı
- Department of Gynecology and Obstetrics, Başkent University School of Medicine, Ankara, Turkey
| |
Collapse
|
12
|
Fox NS, Gettenberg G, Stern E, Schwartz JJ, Kim R, Saltzman DH, Rebarber A. The association between second trimester estimated fetal weight and small for gestational age at birth. J Matern Fetal Neonatal Med 2015; 29:2398-402. [DOI: 10.3109/14767058.2015.1087498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
13
|
Aksoy H, Aksoy Ü, Yücel B, Saygi Özyurt S, Aydın T, Alparslan Babayiğit M. Fetal anterior abdominal wall thickness may be an early ultrasonographic sign of gestational diabetes mellitus. J Matern Fetal Neonatal Med 2015; 29:2028-32. [DOI: 10.3109/14767058.2015.1072164] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
14
|
Conde-Agudelo A, Bird S, Kennedy SH, Villar J, Papageorghiou AT. First- and second-trimester tests to predict stillbirth in unselected pregnant women: a systematic review and meta-analysis. BJOG 2014; 122:41-55. [PMID: 25236870 DOI: 10.1111/1471-0528.13096] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Several biophysical and biochemical tests have been proposed to predict stillbirth but their predictive ability remains unclear. OBJECTIVE To assess the accuracy of tests performed during the first and/or second trimester of pregnancy to predict stillbirth in unselected women with singleton, structurally and chromosomally normal fetuses through use of formal methods for systematic reviews and meta-analytic techniques. SEARCH STRATEGY Electronic databases, bibliographies and conference proceedings. SELECTION CRITERIA Observational studies that evaluated the predictive accuracy for stillbirth of tests performed during the first two trimesters of pregnancy. DATA COLLECTION AND ANALYSIS Two reviewers selected studies, assessed risk of bias and extracted data. Summary receiver operating characteristic curves, pooled sensitivities, specificities and likelihood ratios (LRs) were generated. Data were synthesised separately for stillbirth as a sole category and for specific stillbirth categories. MAIN RESULTS Seventy-one studies, evaluating 16 single and five combined tests, met the inclusion criteria. A uterine artery pulsatility index >90th centile during the second trimester and low levels of pregnancy-associated plasma protein A (PAPP-A) during the first trimester had a moderate to high predictive accuracy for stillbirth related to placental abruption, small-for-gestational-age or pre-eclampsia (positive and negative LRs from 6.3 to 14.1, and from 0.1 to 0.4, respectively). All biophysical and biochemical tests assessed had a low predictive accuracy for stillbirth as a sole category. CONCLUSIONS Currently, there is no clinically useful first-trimester or second-trimester test to predict stillbirth as a sole category. Uterine artery pulsatility index and maternal serum PAPP-A levels appeared to be good predictors of stillbirth related to placental dysfunction disorders.
Collapse
Affiliation(s)
- A Conde-Agudelo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD and Detroit, MI, USA
| | | | | | | | | |
Collapse
|
15
|
Deter RL, Lee W, Sangi-Haghpeykar H, Tarca AL, Yeo L, Romero R. A modified prenatal growth assessment score for the evaluation of fetal growth in the third trimester using single and composite biometric parameters. J Matern Fetal Neonatal Med 2014; 28:745-54. [PMID: 24993892 DOI: 10.3109/14767058.2014.934218] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To define modified Prenatal Growth Assessment Scores (mPGAS) for single and composite biometric parameters and determine their reference ranges in normal fetuses. METHODS Nine anatomical parameters (ap) were measured and the weight estimated (EWTa, EWTb) in a longitudinal study of 119 fetuses with normal neonatal growth outcomes. Expected third trimester size trajectories, obtained from second trimester Rossavik size models, were used in calculating Percent Deviations (% Dev's) and their age-specific reference ranges in each fetus. The components of individual % Dev's values outside their reference ranges, designated +iapPGAS, -iapPGAS, were averaged to give +apPGAS and -apPGAS values for the 3rd trimester. The +iapPGAS and -iapPGAS values for different combinations of ap (c1a (HC, AC, FDL, ThC, EWTa), c1b (HC, AC, FDL, ThC, EWTb), c2 (ThC, ArmC, AVol, TVol), c3 (HC, AC, FDL, EWTa)) were then averaged to give +icPGAS and -icPGAS values at different time points or at the end of the third trimester (+cPGAS, -cPGAS). Values for iapPGAS, ic1bPGAS, and ic2PGAS were compared to their respective apPGAS or cPGAS reference ranges. RESULTS All mPGAS values had one 95% range boundary at 0.0%. Upper boundaries of 1D +apPGAS values ranged from 0.0% (HC) to +0.49% (ThC) and were +0.06%, +2.3% and +1.8% for EWT, AVol and TVol, respectively. Comparable values for -apPGAS were 0.0% (BPD, FDL, HDL), to -0.58% (ArmC), -0.13% (EWT), -0.8% (AVol), and 0.0% (TVol). The +cPGAS, 95% reference range upper boundaries varied from +0.36% (c1b) to +0.89% (c2). Comparable values for -cPGAS lower boundaries were -0.17% (c1b) to -0.43% (c2). CONCLUSIONS The original PGAS concept has now been extended to individual biometric parameters and their combinations. With the standards provided, mPGAS values can now be tested to see if detection of different types of third trimester growth problems is improved.
Collapse
Affiliation(s)
- Russell L Deter
- Department of Obstetrics and Gynecology, Baylor College of Medicine , Houston, TX , USA
| | | | | | | | | | | |
Collapse
|
16
|
Moussa HN, Arian SE, Sibai BM. Management of Hypertensive Disorders in Pregnancy. WOMENS HEALTH 2014; 10:385-404. [DOI: 10.2217/whe.14.32] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Hypertensive disorders are the most common medical complication of pregnancy, with an incidence of 5-10%, and a common cause of maternal mortality in the USA. Incidence of pre-eclampsia has increased by 25% in the past two decades. In addition to being among the lethal triad, there are likely up to 100 other women who experience ‘near miss’ significant maternal morbidity that stops short of death for every pre-eclampsia-related mortality. The purpose of this review is to present the new task force statement and novel definitions, as well as management approaches to each of the hypertensive disorders in pregnancy. The increased understanding of the pathophysiology of hypertension in pregnancy, as well as advances in medical therapy to minimize risks of fetal toxicity and teratogenicity, will improve our ability to prevent and treat hypertension in pregnancy. Fetal programming and fetal origins of adult disease theories extrapolate the benefit of such therapy to future generations.
Collapse
Affiliation(s)
- Hind N Moussa
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, The University of Texas Medical School at Houston, 6431 Fannin, Suite 3.430, Houston, TX 77030, USA
| | - Sara E Arian
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, The University of Texas Medical School at Houston, 6431 Fannin, Suite 3.430, Houston, TX 77030, USA
| | - Baha M Sibai
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, The University of Texas Medical School at Houston, 6431 Fannin, Suite 3.430, Houston, TX 77030, USA
| |
Collapse
|
17
|
Gaillard R, Steegers EA, de Jongste JC, Hofman A, Jaddoe VW. Tracking of fetal growth characteristics during different trimesters and the risks of adverse birth outcomes. Int J Epidemiol 2014; 43:1140-53. [PMID: 24603318 DOI: 10.1093/ije/dyu036] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Fetal growth characteristics are used to identify influences of several maternal characteristics and to identify individuals at increased risk of adverse outcomes. The extent to which fetal growth characteristics track in different trimesters is not known. METHODS In a population-based prospective cohort study among 8636 pregnant women, we examined the extent to which fetal growth characteristics track, are influenced by maternal socio-demographic and lifestyle related determinants and are associated with birth outcomes. Fetal growth was assessed in each trimester and at birth. RESULTS Correlation coefficient between first-trimester crown-rump length and birthweight was r = 0.12 (P-value < 0.05). Correlation coefficients for fetal-head circumference, (femur) length and (estimated) fetal weight ranged from r = 0.16 to r = 0.30 (all P-values < 0.05) between second trimester and birth and from r = 0.36 to r = 0.58 (all P-values < 0.05) between third trimester and birth, and were highest for (estimated) fetal weight. Correlation coefficients for (estimated) fetal weight tended to be lower among overweight mothers, as compared with normal weight mothers, but were not influenced by other maternal characteristics. First, second and third-trimester fetal growth characteristics were associated with risks of preterm birth and small size for gestational age at birth,with the strongest associations present in third trimester. CONCLUSION Fetal growth characteristics track moderately throughout gestation, with stronger tracking coefficients present in later pregnancy. Tracking coefficients were not materially influenced by maternal socio-demographic and lifestyle characteristics. First, second and third trimester fetal growth characteristics were associated with the risk of adverse birth outcomes.
Collapse
Affiliation(s)
- Romy Gaillard
- Generation R Study Group, and Departments of Epidemiology, Paediatrics and Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, The NetherlandsGeneration R Study Group, and Departments of Epidemiology, Paediatrics and Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, The NetherlandsGeneration R Study Group, and Departments of Epidemiology, Paediatrics and Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Eric Ap Steegers
- Generation R Study Group, and Departments of Epidemiology, Paediatrics and Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Johan C de Jongste
- Generation R Study Group, and Departments of Epidemiology, Paediatrics and Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Albert Hofman
- Generation R Study Group, and Departments of Epidemiology, Paediatrics and Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Vincent Wv Jaddoe
- Generation R Study Group, and Departments of Epidemiology, Paediatrics and Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, The NetherlandsGeneration R Study Group, and Departments of Epidemiology, Paediatrics and Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, The NetherlandsGeneration R Study Group, and Departments of Epidemiology, Paediatrics and Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
18
|
D'Antonio F, Khalil A, Thilaganathan B. Second-trimester discordance and adverse perinatal outcome in twins: the STORK multiple pregnancy cohort. BJOG 2013; 121:422-9. [PMID: 24308510 DOI: 10.1111/1471-0528.12467] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to determine the association between biometry discordance at the time of the anomaly scan and adverse perinatal outcomes in twin pregnancies. DESIGN Retrospective cohort study. SETTING Nine hospitals in the Southwest Thames Region of London Obstetric Research Collaborative (STORK). POPULATION OR SAMPLE Population multicentre retrospective study of all twin pregnancies booked for antenatal care in nine hospitals over a period of 10 years. Methods Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to evaluate the association between abdominal circumference (AC) and estimated fetal weight (EFW) discordance, recorded between 20 and 22 weeks of gestation, and adverse pregnancy outcomes. MAIN OUTCOME MEASURES Stillbirth, neonatal mortality, preterm birth (PTB) at <34 weeks of gestation, and birthweight (BW) discordance ≥25%. RESULTS A total of 2399 twin pregnancies [457 monochorionic (MC) and 1942 dichorionic (DC)] were included in the study. The predictive accuracy of the EFW discordance was poor for fetal loss after 22 weeks of gestation (area under the curve, AUC 0.54, 95% CI 0.46-0.64), fetal loss beyond 28 weeks of gestation (AUC 0.42, 95% CI 0.31-0.52), perinatal loss (AUC 0.51, 95% CI 0.44-0.57), BW discordance (AUC 0.63, 95% CI 0.56-0.65), and PTB before 34 weeks of gestation (AUC 0.52, 95% CI 0.49-0.55). There was no significant difference in the prediction of these outcomes when using EFW discordance or AC discordance. CONCLUSIONS Once structural malformations, chromosomal abnormalities, and twin-to-twin transfusion syndrome have been excluded, second-trimester EFW and AC discordance have poor predictive value for adverse perinatal outcomes in twin pregnancy.
Collapse
Affiliation(s)
- F D'Antonio
- Fetal Medicine Unit, Division of Developmental Sciences, St George's, University of London, London, UK
| | | | | | | |
Collapse
|
19
|
Saha E, Mullins EWS, Paramasivam G, Kumar S, Lakasing L. Perinatal outcomes of fetal echogenic bowel. Prenat Diagn 2012; 32:758-64. [PMID: 22589170 DOI: 10.1002/pd.3898] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate perinatal outcomes of fetal echogenic bowel (FEB). METHOD This is a retrospective observational study of FEB cases from Jan 2005-Dec 2010. Data from ultrasound and fetal medicine investigations, uterine artery Doppler (UAD), intra-partum care and neonatal outcome were obtained from Fetal Medicine, Obstetric and Neonatal Databases. RESULTS There were 139 cases presenting at 21(+5) (15(+1) -35(+5) ) weeks gestation. Overall, 106/139 (76.2%) were live born (LB), 8/139 (5.8%) were complicated by intra-uterine deaths (IUD), 11/139 (7.9%) had termination of pregnancy (TOP) and 14/139 (10.1%) were lost to follow-up after 28 weeks gestation. Six had chromosomal/genetic abnormalities, two had congenital cytomegalovirus, none had cystic fibrosis.Uterine artery Doppler was normal in 106/130 (81.5%) cases. In this group, there were no cases of fetal growth restriction (FGR), 95/106 (89.6%) were LB, 1/106 (0.94%) had an IUD. In the abnormal UAD group, 17/24 (70.1%) developed FGR, 11/24 (45.8%) were LB, 4/24 (16.7%) had TOP, 7/24 (29.2%) had IUD.In total, 20/106 (18.9%) live births were admitted for specialist neonatal care, 12/20 (60%) for prematurity. Only one had primary bowel pathology. CONCLUSION Pregnancies with FEB and screen positive UAD are at risk of adverse perinatal outcome. Primary bowel pathology is rare following the finding of FEB.
Collapse
Affiliation(s)
- Esha Saha
- Department of Fetal Medicine, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | | | | | | | | |
Collapse
|
20
|
Fox NS, Saltzman DH, Schwartz R, Roman AS, Klauser CK, Rebarber A. Second-trimester estimated fetal weight and discordance in twin pregnancies: association with fetal growth restriction. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:1095-1101. [PMID: 21795485 DOI: 10.7863/jum.2011.30.8.1095] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The purpose of this study was to estimate the association between second-trimester estimated fetal weight and fetal growth restriction in twin pregnancies. METHODS A historical cohort of 306 twin pregnancies from a single center was analyzed. Estimated fetal weight and discordance at 18 to 24 weeks were calculated. Patients with a fetus whose second-trimester estimated fetal weight was below the 10th percentile were compared to patients with both fetuses at or above the 10th percentile. Also, patients with second-trimester discordance of 15% or greater were compared to patients with discordance of less than 15%. RESULTS Second-trimester discordance was significantly smaller than birth weight discordance (mean discordance ± SD, 7.41% ± 6.06% versus 11.43% ± 9.6%, respectively; P < .001). Patients with second-trimester discordance of 15% or greater were significantly more likely to deliver a twin with a birth weight below the 10th percentile for gestational age (67.7% versus 44.1%; P = .012) and below the 5th percentile for gestational age (41.9% versus 22.8%; P = .019). Patients with a second-trimester estimated fetal weight below the 10th percentile were significantly more likely to deliver a twin with a birth weight below the 10th percentile for gestational age (65.5% versus 44.5%; P = .031) and below the 5th percentile for gestational age (55.2% versus 21.5%; P < .001). CONCLUSIONS In twin pregnancies, second-trimester estimated fetal weight below the 10th percentile and discordance of 15% or greater are associated with fetal growth restriction.
Collapse
Affiliation(s)
- Nathan S Fox
- Maternal-Fetal Medicine Associates, PLLC, 70 E 90th St, New York, NY 10128, USA.
| | | | | | | | | | | |
Collapse
|
21
|
Marsoosi V, Pirjani R, Jamal A, Eslamian L, Rahimi-Foroushani A. Second trimester biparietal diameter size and the risk of adverse pregnancy outcomes. Prenat Diagn 2011; 31:995-8. [DOI: 10.1002/pd.2823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 06/09/2011] [Accepted: 06/09/2011] [Indexed: 11/05/2022]
|
22
|
Schwartz N, Pessel C, Coletta J, Krieger AM, Timor-Tritsch IE. Early biometric lag in the prediction of small for gestational age neonates and preeclampsia. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:55-60. [PMID: 21193705 DOI: 10.7863/jum.2011.30.1.55] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE An early fetal growth lag may be a marker of future complications. We sought to determine the utility of early biometric variables in predicting adverse pregnancy outcomes. METHODS In this retrospective cohort study, the crown-rump length at 11 to 14 weeks and the head circumference, biparietal diameter, abdominal circumference, femur length, humerus length, transverse cerebellar diameter, and estimated fetal weight at 18 to 24 weeks were converted to an estimated gestational age using published regression formulas. Sonographic fetal growth (difference between each biometric gestational age and the crown-rump length gestational age) minus expected fetal growth (number of days elapsed between the two scans) yielded the biometric growth lag. These lags were tested as predictors of small for gestational age (SGA) neonates (≤10th percentile) and preeclampsia. RESULTS A total of 245 patients were included. Thirty-two (13.1%) delivered an SGA neonate, and 43 (17.6%) had the composite outcome. The head circumference, biparietal diameter, abdominal circumference, and estimated fetal weight lags were identified as significant predictors of SGA neonates after adjusted analyses (P < .05). The addition of either the estimated fetal weight or abdominal circumference lag to maternal characteristics alone significantly improved the performance of the predictive model, achieving areas under the curve of 0.72 and 0.74, respectively. No significant association was found between the biometric lag variables and the development of preeclampsia. CONCLUSIONS Routinely available biometric data can be used to improve the prediction of adverse outcomes such as SGA. These biometric lags should be considered in efforts to develop screening algorithms for adverse outcomes.
Collapse
Affiliation(s)
- Nadav Schwartz
- Department of Obstetrics and Gynecology, Maternal and Child Health Research Program, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
| | | | | | | | | |
Collapse
|
23
|
Salvig JD, Kirkegaard I, Winding TN, Henriksen TB, Tørring N, Uldbjerg N. Low PAPP-A in the first trimester is associated with reduced fetal growth rate prior to gestational week 20. Prenat Diagn 2010; 30:503-8. [PMID: 20509148 DOI: 10.1002/pd.2487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To evaluate the association between maternal pregnancy-associated plasma protein-A (PAPP-A) and fetal growth from the first to the second trimester. METHODS A prospective cohort study including 8347 pregnant women attending prenatal care at Aarhus University Hospital were conducted. PAPP-A was measured during 8 to 14 gestational weeks. Fetal growth between the two scans in the first and second trimesters was estimated by (GA(20)- GA(12))/Days(calendar), where GA(12) reflects gestational age in days calculated from crown-rump length at a 12-week scan, GA(20) reflects gestational age in days calculated from biparietal diameter at a 20-week scan, and Days(calendar) reflects the number of calendar days between the two scans. RESULTS Fetal growth rate from the first to the second trimester was correlated with PAPP-A, with a regression coefficient of 0.009 (95% CI, 0.007-0.012, P < 0.001). PAPP-A below 0.30 MoM was associated with a fetal growth rate below the tenth centile, with an adjusted OR of 2.05 (95% CI, 1.24-3.38). CONCLUSION Low levels of PAPP-A are associated not only with low birth weight at term but also with slower fetal growth prior to 20 weeks of gestation.
Collapse
Affiliation(s)
- J D Salvig
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Skejby, DK-8200 Aarhus N, Denmark.
| | | | | | | | | | | |
Collapse
|
24
|
Fox NS, Chasen ST. First trimester pregnancy associated plasma protein-A as a marker for poor pregnancy outcome in patients with early-onset fetal growth restriction. Prenat Diagn 2009; 29:1244-8. [DOI: 10.1002/pd.2397] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
25
|
Fox NS, Shalom D, Chasen ST. Second-trimester fetal growth as a predictor of poor obstetric and neonatal outcome in patients with low first-trimester serum pregnancy-associated plasma protein-A and a euploid fetus. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:34-38. [PMID: 19115230 DOI: 10.1002/uog.6274] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To examine if fetal growth during the second trimester predicts poor pregnancy and neonatal outcome in patients with low first-trimester serum pregnancy-associated plasma protein-A (PAPP-A) and a euploid fetus. METHODS We identified all patients with first-trimester PAPP-A<5th centile who had undergone first- and second-trimester ultrasound examination. We excluded multiple pregnancies and those with aneuploidy or major anomalies identified before or after birth. We compared pregnancies with and without ultrasound markers for fetal growth restriction at 18-24 weeks. RESULTS We identified 239 patients with low PAPP-A, 25 (10.5%) of whom had evidence of fetal growth restriction at 18-24 weeks. These 25 cases had significantly higher rates of third-trimester small-for-gestational age (SGA) fetus, gestational hypertension, preterm birth, indicated preterm birth, low birth weight and birth weight centiles, 1-min Apgar score<7, neonatal intensive care unit admission and fetal or neonatal death. CONCLUSION Among patients with low first-trimester PAPP-A and a euploid fetus, fetal growth in the second trimester can predict poor obstetric and neonatal outcome.
Collapse
Affiliation(s)
- N S Fox
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY 10128, USA.
| | | | | |
Collapse
|