Antenatal detection of fetal growth restriction and risk of stillbirth: population‐based case–control study

Ego, Anne; Monier, Isabelle; Skaare, Kristina; Zeitlin, Jennifer

doi:10.1002/uog.20414

Cited by 39 publications

(29 citation statements)

References 52 publications

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“…The more marked decline in Scotland, compared with in England and Wales, as a result of these interventions may be, for example, due to the greater absolute decline in smoking rate in Scotland following the cessation policy or the greater absolute increase in the uptake of antenatal care in the first trimester in Scotland compared to in England (from 65% in 2011 to 82% in 2015 vs 89% in 2010 to 92% in 2015). The liberal use of third‐trimester ultrasound along with Doppler studies may have been a contributing factor to the overall declining stillbirth rate.…”

Section: Discussionmentioning

confidence: 99%

UK stillbirth trends in over 11 million births provide no evidence to support effectiveness of Growth Assessment Protocol program

Iliodromiti

Smith

Lawlor

et al. 2020

Ultrasound in Obstet & Gyne

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CONTRIBUTION What are the novel findings of this work?The recent reduction in stillbirths in England and Wales cannot be attributed solely to the introduction of the Growth Assessment Protocol (GAP) program. The greater decline in the stillbirth rate in Scotland, despite the low uptake of the program, suggests that other beneficial public health measures common to both systems are responsible. What are the clinical implications of this work?Further implementation of the GAP program and use of customized growth centiles is not warranted on the basis of our findings. ABSTRACTObjective Use of the Growth Assessment Protocol (GAP) has increased internationally under the assumption that it reduces the stillbirth rate. The evidence for this is limited and based largely on an ecological time-trend study. Discordance in the uptake of the GAP program between Scotland and England/Wales enabled us to assess the assertion that implementation of GAP leads to a reduced stillbirth rate.Methods We analyzed data from the National Records for Scotland and the Office for National Statistics on the number of singleton maternities and stillbirths in Scotland and in England and Wales, respectively, from 1 January 2000 to 31 December 2015. National uptake of the GAP program over time in each of the regions was recorded. Stillbirth rate per 1000 maternities was calculated, according to year of delivery, and compared between Scotland and England/Wales. ResultsDuring the study period, there were 870 632 singleton maternities in Scotland, of which 4243 were stillbirths, and there were 10 469 120 singleton maternities in England and Wales, of which 51 562 were stillbirths. There was a marked difference in uptake of the GAP program between the two regions, with substantially fewer maternity units in Scotland implementing the program. Stillbirth rates were static up to 2010, with a decline thereafter in both regions, to 3.75 (95% CI, per 1000 maternities in Scotland and 4.30 (95% CI, 4.15-4.46) per 1000 maternities in England and Wales in 2015. From 2010 fewer stillbirths per 100 000 maternities in Scotland than in England and Wales from 2010 to 2015 compared with 2000 to 2009. ConclusionsWe observed a decline in stillbirth rate in England and Wales, which coincided with implementation of the GAP program. However, a concurrent decline in stillbirth rate was observed in Scotland in the absence of increased implementation of GAP. The secular rates of change in stillbirth rate in England and Wales cannot be used to infer efficacy of the GAP program.

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Section: Discussionmentioning

confidence: 99%

UK stillbirth trends in over 11 million births provide no evidence to support effectiveness of Growth Assessment Protocol program

Iliodromiti

Smith

Lawlor

et al. 2020

Ultrasound in Obstet & Gyne

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“…On the other hand, double-positive cases (positive result for both aneuploidy and preterm SGA) are at the highest risk for SGA/FGR. This information is useful later on in pregnancy when suspicion of SGA can lead to a two-fold decrease in the frequency of stillbirth 13,39 , and a structured program of surveillance for those identified as SGA is related to a four-fold lower risk of adverse fetal outcome 14 .…”

Section: Discussionmentioning

confidence: 99%

First‐trimester prediction of small‐for‐gestational age in pregnancies at false‐positive high or intermediate risk for fetal aneuploidy

Yarygina

Bataeva

Benitez

et al. 2020

Ultrasound in Obstet & Gyne

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Objectives To explore the risk of small‐for‐gestational age (SGA) and fetal growth restriction (FGR) and to test the performance of first‐trimester screening for SGA and FGR in women with a false‐positive high or intermediate risk for aneuploidy. Methods This was a prospective cohort study of women with a singleton pregnancy attending for a routine first‐trimester scan. The risks of aneuploidy and preterm SGA (defined as birth weight < 10th percentile with delivery before 37 weeks) were determined according to Fetal Medicine Foundation algorithms. In non‐malformed euploid pregnancies, the predictive performance of both the aneuploidy and preterm SGA risks was evaluated for SGA, FGR (defined as birth weight < 3rd centile), preterm SGA and early SGA (delivery before 34 weeks), using receiver‐operating‐characteristics (ROC) curve analysis, in those with a high or intermediate risk of aneuploidy and in the overall population. Results A total of 2053 pregnancies were included in the analysis, of which 191 (9.3%) were at high or intermediate risk for aneuploidy (≥ 1/1000) and 304 (14.8%) were at high risk for preterm SGA (≥ 1/100). In total, there were 140 (6.8%) cases of SGA, 61 (3.0%) of FGR, 44 (2.1%) of preterm SGA and 33 (1.6%) of early SGA. Among women with a false‐positive high or intermediate risk for aneuploidy, the rates of SGA, FGR, preterm SGA and early SGA were 13.6% (26/191), 7.9 % (15/191), 6.8% (13/191) and 5.8% (11/191), respectively. Compared with women with a first‐trimester low risk for preterm SGA, regardless of aneuploidy risk, those with a high risk for preterm SGA and a high or intermediate risk for aneuploidy had relative risks for SGA, FGR, preterm SGA and early SGA of 6 (95% CI, 3.9–9), 9.2 (95% CI, 5.1–16.5), 13.4 (95% CI, 6.9–26.1) and 17.6 (95% CI, 8.1–38.2), respectively. The predictive performance for SGA of the preterm SGA algorithm was higher in women at high or intermediate risk for aneuploidy than in the overall population (area under the ROC curve (AUC), 0.8 vs 0.7; P < 0.001). Among women at high or intermediate risk for aneuploidy, the predictive performance of the preterm SGA algorithm was better than that of the aneuploidy algorithm for SGA (AUC, 0.80 vs 0.58; P = 0.003), preterm SGA (AUC, 0.85 vs 0.65; P = 0.013) and early SGA (AUC, 0.86 vs 0.60; P = 0.002). Conclusion In women with a first‐trimester false‐positive high or intermediate risk of aneuploidy, further screening for SGA allows stratification of the risk for fetal growth disorders. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

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“…Antenatal diagnosis of FGR is essential, since this has a positive effect not only on the course of pregnancy but also on neonatal outcome [2,25]. Despite closely monitored management internationally and also in Germany, the number of unidentified antenatal FGR cases is still large [1,25].…”

Section: Screening Prediction and Preventionmentioning

confidence: 99%

“…Das antenatale Erkennen einer FGR ist essenziell, da neben dem Schwangerschaftsverlauf auch das neonatale Outcome positiv beeinflusst wird 2 , 25 . Nach wie vor werden international und auch in Deutschland trotz der engmaschigen Betreuung ein Großteil der FGR-Fälle pränatal nicht detektiert 1 , 25 .…”

Section: Screening Prädiktion Und Präventionunclassified

Fetal Growth Restriction – Diagnostic Work-up, Management and Delivery

Schlembach

2020

Geburtshilfe Frauenheilkd

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Fetal or intrauterine growth restriction (FGR/IUGR) affects approximately 5 – 8% of all pregnancies and refers to a fetus not exploiting its genetically determined growth potential. Not only a major cause of perinatal morbidity and mortality, it also predisposes these fetuses to the development of chronic disorders in later life. Apart from the timely diagnosis and identification of the causes of FGR, the obstetric challenge primarily entails continued antenatal management with optimum timing of delivery. In order to minimise premature birth morbidity, intensive fetal monitoring aims to prolong the pregnancy and at the same time intervene, i.e. deliver, before the fetus is threatened or harmed. It is important to note that early-onset FGR (< 32 + 0 weeks of gestation [wks]) should be assessed differently than late-onset FGR (≥ 32 + 0 wks). In early-onset FGR progressive deterioration is reflected in abnormal venous Doppler parameters, while in late-onset FGR this manifests primarily in abnormal cerebral Doppler ultrasound. According to our current understanding, the “optimum” approach for monitoring and timing of delivery in early-onset FGR combines computerized CTG with the ductus venosus Doppler, while in late-onset FGR assessment of the cerebral Doppler parameters becomes more important.

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Antenatal detection of fetal growth restriction and risk of stillbirth: population‐based case–control study

Cited by 39 publications

References 52 publications

UK stillbirth trends in over 11 million births provide no evidence to support effectiveness of Growth Assessment Protocol program

UK stillbirth trends in over 11 million births provide no evidence to support effectiveness of Growth Assessment Protocol program

First‐trimester prediction of small‐for‐gestational age in pregnancies at false‐positive high or intermediate risk for fetal aneuploidy

Fetal Growth Restriction – Diagnostic Work-up, Management and Delivery

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