Competing‐risks model for prediction of small‐for‐gestational‐age neonate at 36 weeks' gestation

Abstract

What are the novel findings of this work?Our study has developed further a competing-risks model for the prediction of a small-for-gestational-age (SGA) neonate using maternal demographic characteristics and medical history, third-trimester fetal biometry, uterine artery pulsatility index and placental growth factor at 35−37 weeks' gestation, which has shown superior performance compared with estimated-fetal-weight percentile cut-offs. What are the clinical implications of this work?Application of a competing-risks model at 36 weeks' gestation provides effective risk stratification for a SGA neonate, in contrast to the traditional method of estimated-fetal-weight percentile cut-off.

Prediction of adverse perinatal outcome at midgestation

“…The first crucial step is to identify effectively the condition early so that growth‐restricted fetuses are diagnosed promptly and receive evidence‐based care. This can be achieved by our model, as we have proved in several studies 9–14 . We propose that effective identification should be linked with, first, an appropriate stratification scheme that aims to personalize the timing when third‐trimester assessment should be initiated and, second, the timing for delivery, balancing the need for early delivery to avoid the risk of stillbirth and hypoxia, but not too early so that the incidence of adverse neonatal outcomes due to prematurity can be minimized.…”

“…In a series of publications, a new competing-risks model for SGA has been developed and validated [9][10][11][12][13][14][15] . This model is based on the concept that SGA is more severe the smaller the baby is and the earlier it is delivered.…”

Audit of fetal biometry: understanding sources of error to improve our practice

“…Ongoing audit of the measurement of NT has had a pivotal role in the quality assurance and widespread application of the method 7 and was made possible by the use of a single, universally applicable NT standard that provides a solid foundation for subsequent combined screening. Obstetric care is increasingly based on algorithms that combine maternal factors with biophysical measurements of the mother and fetus [4][5][6]29,30 . The management of the major obstetric conditions can be based on prediction models applicable at different stages of pregnancy 1 .…”

“…We must move forward to an integrated early-risk assessment for smallness/growth restriction and macrosomia, in which EFW is a potent biomarker amongst others 1,[4][5][6] . This should allow effective stratification and personalization of care 1,[4][5][6] . A prerequisite for this new era of precision medicine is correct ultrasound measurements according to strict criteria and stringent standardization of our practices and standards at each of the steps (pregnancy dating, biometric measurements, EFW formulas, prescriptive standards used).…”

“…Prediction models that aim to personalize care utilize the information from fetal biometry after adjustment for gestational age [4][5][6] . This adjustment requires the use of appropriate reference ranges for gestational age.…”