Consequences of Misdiagnosis of Intrauterine Growth Retardation for Preterm Elective Cesarean Section

Ringa, Virginie; Carrat, Fabrice; Blondel, Béatrice; Breart, Gérard

doi:10.1159/000263847

Cited by 11 publications

(6 citation statements)

References 10 publications

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“…Our analysis of the indications for induction and pre‐labour caesareans also support this interpretation. One previous study from the 1990s also documented higher rates of caesarean section among false positives in two tertiary centres …”

Section: Discussionmentioning

confidence: 84%

Poor effectiveness of antenatal detection of fetal growth restriction and consequences for obstetric management and neonatal outcomes: a French national study

Monier

Blondel

Ego

et al. 2014

BJOG

150

100

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Objective To assess the proportion of small for gestational age (SGA) and normal birthweight infants suspected of fetal growth restriction (FGR) during pregnancy, and to investigate obstetric and neonatal outcomes by suspicion of FGR and SGA status at birth.Design Population-based study.Setting All French maternity units in 2010.Population Representative sample of singleton births (n = 14 100).Methods We compared SGA infants with a birthweight of less than the 10th percentile suspected of FGR, defined as mention of FGR in medical charts (true positives), non-SGA infants suspected of FGR (false positives), SGA infants without suspicion of FGR (false negatives) and non-SGA infants without suspicion of FGR (true negatives). Multivariable analyses were adjusted for maternal and neonatal characteristics hypothesised to affect closer surveillance for FGR and our outcomes.Main outcome measures Obstetric management (caesarean, provider-initiated preterm and early term delivery) and neonatal outcomes (late fetal death, preterm birth, Apgar score, resuscitation at birth).Results 21.7% of SGA infants (n = 265) and 2.1% of non-SGA infants (n = 271) were suspected of FGR during pregnancy. Compared with true negatives, provider-initiated preterm deliveries were higher for true and false positives (adjusted risk ratio [aRR], 6.1 [95% CI,.7]), but not for false negatives (aRR, 1.1 [95% CI, 0.6-1.9]). Neonatal outcomes were not better for SGA infants if FGR was suspected.Conclusion Antenatal suspicion of FGR among SGA infants was low and one-half of infants suspected of FGR were not SGA. The increased risk of provider-initiated delivery observed in non-SGA infants suspected of FGR raises concerns about the iatrogenic consequences of screening.

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Section: Discussionmentioning

confidence: 84%

Poor effectiveness of antenatal detection of fetal growth restriction and consequences for obstetric management and neonatal outcomes: a French national study

Monier

Blondel

Ego

et al. 2014

BJOG

150

100

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“…Therefore to avoid one perinatal death it would be necessary to perform 1000 umbilical Doppler examinations. Furthermore, benefit may be outweighed by the consequences of the false positives 20 .…”

Section: Discussionmentioning

confidence: 99%

Umbilical artery Doppler velocimetry in unselected and low risk pregnancies: a review of randomised controlled trials

Goffinet

Paris-Llado

Nisand

et al. 1997

BJOG

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Objective Meta-analysis of data from controlled trials performed in populations at high risk have shown that umbilical artery Doppler velociinetry (umbilical Doppler) can reduce perinatal mortality. The individual published trials among unselected or low risk populations have found no beneficial effect. Our objective was to evaluate the effect of routine use of the umbilical Doppler in unselected or low risk pregnancies by reviewing all published and unpublished randomised controlled trials.Study design Systematically reviewing published and unpublished trials, we selected trials for the overview only if they were completed randomised trials of umbilical Doppler in unselected or low risk pregnancies. Of the seven trials examined, three were not included in the meta-analysis because of methodological problems or because they did not meet the inclusion criteria. We therefore included four trials: two in unselected and two in low risk populations. These four groups were comparable in their degree of maternal and perinatal risk. Using the Mantel-Haenzel statistical method and pooling the data, we considered 1 1,375 women in the meta-analysis. Results Systematic use of the Doppler umbilical artery velocimetry had no statistically significant effect on perinatal deaths in unselected populations (odds ratio [OR] 1-28; 95% confidence interval [CI]0.61-2-67), low risk populations (OR 0.5 1; 95% CI 0.20-1-29) or overall for the four trials (OR 0.90; 95% CI 0.50-1.60); nor was there any significant effect on stillbirths (global OR 0-94; 95% CI 0.42-1.98). However, the number of participants remain insufficient and further information is required to arrive at a definite conclusion on the absence of effect. The meta-analysis showed no significant difference between the Doppler groups and the control groups for antenatal hospitalisation, obstetric outcome or perinatal morbidity.Conclusion Based on the results of the published trials, routine use of the umbilical Doppler cannot be recommended.

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“…In addition, neonatal admission to the NICU was 2.2 times more likely in the FP group than in the TN group, which may be due to planned early induction of delivery (before 37 weeks) and early elective Cesarean section for fetal indication. The negative impact of SGA screening has been described previously by Ringa et al . in 1993, who showed that a larger number of interventions performed for SGA were related to the findings at ultrasound screening.…”

Section: Discussionmentioning

confidence: 55%

Impact on obstetric outcome of third‐trimester screening for small‐for‐gestational‐age fetuses

Callec

Lamy

Perdriolle-Galet

et al. 2015

Ultrasound in Obstet & Gyne

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Consequences of Misdiagnosis of Intrauterine Growth Retardation for Preterm Elective Cesarean Section

Cited by 11 publications

References 10 publications

Poor effectiveness of antenatal detection of fetal growth restriction and consequences for obstetric management and neonatal outcomes: a French national study

Poor effectiveness of antenatal detection of fetal growth restriction and consequences for obstetric management and neonatal outcomes: a French national study

Umbilical artery Doppler velocimetry in unselected and low risk pregnancies: a review of randomised controlled trials

Impact on obstetric outcome of third‐trimester screening for small‐for‐gestational‐age fetuses

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