Abstract
Objectives: To perform a longitudinal assessment comparison between estimated fetal weight (EFW) and abdominal circumference (AC) in the prediction of late fetal growth restriction (FGR) as opposed to small for gestational age (SGA). Patients and Methods: A cohort of unselected singleton pregnancies scanned at 32±2 and 37±1 weeks was created. Longitudinal growth assessment by calculating the conditional AC and conditional EFW was performed, and both parameters were compared for their prediction capacity for late FGR and SGA. Conditional standards set an expected size (EFW or AC) given a first measurement performed earlier. A declining growth was defined as a conditional growth of <10th centile. Results: A total of 938 pregnancies were included. As expected, declining growth between 32±2 and 37±1 weeks was associated with late FGR and SGA, but the predictive capacity of both conditional AC and conditional EFW was comparably poor, with detection rates of 28% at a 10% rate of false positives for late FGR. Conclusions: Longitudinal assessment of fetal growth during the third trimester has a low predictive capacity for late FGR, with no differences between conditional AC and conditional EFW.
References
1.
Lackman F, Capewell V, Gagnon R, Richardson B: Fetal umbilical cord oxygen values and birth to placental weight ratio in relation to size at birth. Am J Obstet Gynecol 2001; 185: 674–682.
2.
Figueras F, Gardosi J: Intrauterine growth restriction: new concepts in antenatal surveillance, diagnosis, and management. Am J Obstet Gynecol 2011; 204: 288–300.
3.
Gardosi J, Mul T, Mongelli M, Fagan D: Analysis of birthweight and gestational age in antepartum stillbirths. Br J Obstet Gynecol 1998; 105: 524–530.
4.
Lindqvist PG, Molin J: Does antenatal identification of small-for-gestational age fetuses significantly improve their outcome? Ultrasound Obstet Gynecol 2005; 25: 258–264.
5.
Figueras F, Gratacós E: Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol. Fetal Diagn Ther 2014; 36: 86–98.
6.
Savchev S, Figueras F, Sanz-Cortes M, Cruz-Lemini M, Triunfo S, Botet F, Gratacos E: Evaluation of an optimal gestational age cut-off for the definition of early-and late-onset fetal growth restriction. Fetal Diagn Ther 2013; 36: 99–105.
7.
Parra-Saavedra M, Crovetto F, Triunfo S, Savchev S, Peguero A, Nadal A, Parra G, Gratacos E, Figueras F: Placental findings in late-onset SGA births without Doppler signs of placental insufficiency. Placenta 2013; 34: 1136–1141.
8.
Gratacos E: Towards an integrated third-trimester screening in pregnancy. Fetal Diagn Ther 2013; 33: 141–142.
9.
Gratacos E, Figueras F: Fetal growth restriction as a perinatal and long-term health problem: clinical challenges and opportunities for future (4P) fetal medicine. Fetal Diagn Ther 2014; 36: 85.
10.
Gardosi J, Madurasinghe V, Williams M, Malik A, Francis A: Maternal and fetal risk factors for stillbirth: population based study. BMJ 2013; 346:f108.
11.
Pilliod RA, Cheng YW, Snowden JM, Doss AE, Caughey AB: The risk of intrauterine fetal death in the small-for-gestational-age fetus. Am J Obstet Gynecol 2012; 207: 318.e1–6.
12.
Sovio U, White IR, Dacey A, Pasupathy D, Smith GC: Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study. Lancet 2015; 386: 2089–2097.
13.
Royston P: Calculation of unconditional and conditional reference intervals for foetal size and growth from longitudinal measurements. Stat Med 1995; 14: 1417–1436.
14.
Mongelli M, Gardosi J: Longitudinal study of fetal growth in subgroups of a low-risk population. Ultrasound Obstet Gynecol 1995; 6: 340–344.
15.
Chang TC, Robson SC, Boys RJ, Spencer JA: Prediction of the small for gestational age infant: which ultrasonic measurement is best? Obstet Gynecol 1992; 80: 1030–1038.
16.
Di Lorenzo G, Monasta L, Ceccarello M, Cecotti V, D’Ottavio G: Third trimester abdominal circumference, estimated fetal weight and uterine artery doppler for the identification of newborns small and large for gestational age. Eur J Obstet Gynecol Reprod Biol 2013; 166: 133–138.
17.
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 Obstet Gynecol 2015; 45: 559–565.
18.
Ott WJ: Diagnosis of intrauterine growth restriction: comparison of ultrasound parameters. Am J Perinatol 2002; 19: 133–137.
19.
Simon NV, O’Connor TJ 3rd, Shearer DM: Detection of intrauterine fetal growth retardation with abdominal circumference and estimated fetal weight using cross-sectional growth curves. J Clin Ultrasound 1990; 18: 685–690.
20.
Robinson HP, Fleming JE: A critical evaluation of sonar “crown-rump length” measurements. Br J Obstet Gynaecol 1975; 82: 702–710.
21.
Figueras F, Meler E, Iraola A, Eixarch E, Coll E, Figueras J, Francis A, Gratacos E, Gardosi J: Customized birthweight standards for a Spanish population. Eur J Obstet Gynecol Reprod Biol 2008; 136: 20–24.
22.
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370: 1453–1457.
23.
Salomon LJ, Alfirevic Z, Berghella V, Bilardo C, Hernandez-Andrade E, Johnsen SL, Kalache K, Leung KY, Malinger G, Munoz H, Prefumo F, Toi A, Lee W: Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol 2011; 37: 116–126.
24.
Hadlock FP, Harrist R, Sharman RS, Deter RL, Park SK: Estimation of fetal weight with the use of head, body, and femur measurements – a prospective study. Am J Obstet Gynecol 1985; 151: 333–337.
25.
Figueras F, Fernandez S, Eixarch E, Gomez O, Martinez JM, Puerto B, Gratacos E: Middle cerebral artery pulsatility index: reliability at different sampling sites. Ultrasound Obstet Gynecol 2006; 28: 809–813.
26.
Baschat AA, Gembruch U: The cerebroplacental Doppler ratio revisited. Ultrasound Obstet Gynecol 2003; 21: 124–127.
27.
Gomez O, Figueras F, Fernandez S, Bennasar M, Martinez JM, Puerto B, Gratacos E: Reference ranges for uterine artery mean pulsatility index at 11–41 weeks of gestation. Ultrasound Obstet Gynecol 2008; 32: 128–132.
28.
Gregg AR, Weiner CP: “Normal” umbilical arterial and venous acid-base and blood gas values. Clin Obstet Gynecol 1993; 36: 24–32.
29.
Basuki TR, Triunfo S, Caradeux J, Eixarch E, Hansson S, Gratacos E, Figueras F: Third-trimester conditional references for longitudinal fetal growth assessment. Fetal Diagn Ther 2017, Epub ahead of print.
30.
DeLong E, DeLong DM, Clarke-Pearson D: Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988; 44: 837–845.
31.
Trudell AS, Cahill AG, Tuuli MG, Macones GA, Odibo AO: Risk of stillbirth after 37 weeks in pregnancies complicated by small-for-gestational-age fetuses. Am J Obstet Gynecol 2013; 208: 376.e1–7.
32.
Owen P, Burton K, Ogston S, Khan KS, Howie PW: Using unconditional and conditional standard deviation scores of fetal abdominal area measurements in the prediction of intrauterine growth restriction. Ultrasound Obstet Gynecol 2000; 16: 439–444.
33.
Karlsen HO, Johnsen SL, Rasmussen S, Kiserud T: Prediction of adverse perinatal outcome of small-for-gestational-age pregnancy using size centiles and conditional growth centiles. Ultrasound Obstet Gynecol 2016; 48: 217–223.
34.
Hutcheon JA, Egeland GM, Morin L, Meltzer SJ, Jacobsen G, Platt RW: The predictive ability of conditional fetal growth percentiles. Paediatr Perinat Epidemiol 2010; 24: 131–139.
35.
Souka AP, Papastefanou I, Pilalis A, Michalitsi V, Kassanos D: Performance of third-trimester ultrasound for prediction of small-for-gestational-age neonates and evaluation of contingency screening policies. Ultrasound Obstet Gynecol 2012; 39: 535–542.
36.
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 Obstet Gynecol 2016; 47: 81–88.
37.
Karlsen HO, Johnsen SL, Rasmussen S, Kiserud T: Prediction of adverse neonatal outcomes using size centiles and conditional growth centiles. Ultrasound Obstet Gynecol 2016; 48: 217–223.
38.
Royston P, Altman D: Design and analysis of longitudinal studies of fetal size. Ultrasound Obstet Gynecol 1995; 6: 307–312.
39.
Pilalis A, Souka AP, Papastefanou I, Michalitsi V, Panagopoulos P, Chrelias C, Kassanos D: Third trimester ultrasound for the prediction of the large for gestational age fetus in low-risk population and evaluation of contingency strategies. Prenat Diagn 2012; 32: 846–853.
40.
Vasak B, Koenen SV, Koster MP, Hukkelhoven CW, Franx A, Hanson MA, Visser GH: Human fetal growth is constrained below optimal for perinatal survival. Ultrasound Obstet Gynecol 2015; 45: 162–167.
41.
Deter RL, Rossavik IK, Harrist RB, Hadlock FP: Mathematic modeling of fetal growth: development of individual growth curve standards. Obstet Gynecol 1986; 68: 156–161.
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2018
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