Performance of third‐trimester combined screening model for prediction of adverse perinatal outcome

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CONTRIBUTION What are the novel findings of this work?This study provides evidence of a higher risk of adverse outcome in suspected third-trimester small-forgestational-age (SGA) fetuses with abnormal uterine artery Doppler, which is comparable to that in late SGA fetuses with abnormal cerebroplacental ratio. What are the clinical implications of this work?The findings from this study should enable clinicians to assess the risk of adverse perinatal outcome in SGA fetuses, using the likelihood ratios of abnormal third-trimester uterine artery Doppler to calculate the posterior probability, using an evidence-based approach. ABSTRACTObjective To investigate the predictive ability for adverse perinatal outcome of abnormal third-trimester uterine artery Doppler in late small-for-gestational-age (SGA) fetuses.Methods A systematic search was performed to identify relevant observational studies and randomized controlled trials evaluating the performance of abnormal third-trimester uterine artery Doppler for the prediction of adverse perinatal outcome in suspected SGA fetuses and SGA neonates. Abnormal uterine artery Doppler was defined as uterine artery pulsatility index > 95 th percentile or ≥ 2 SD above the mean, or bilateral uterine artery notching. Hierarchical summary receiver-operating-characteristics (ROC) curves were con-structed using random-effects modeling. Bayesian analysis was used to calculate the posterior probability of adverse perinatal outcome following an abnormal or normal uterine artery Doppler assessment.Results Seventeen observational studies (including 7552 fetuses either diagnosed with suspected SGA (n = 3461) or later diagnosed as a SGA neonate (n = 4091)) met the inclusion criteria; no randomized-controlled trials met the inclusion criteria. Summary ROC curves showed that, among suspected SGA fetuses, the best predictive accuracy of abnormal third-trimester uterine artery Doppler was for perinatal mortality and the worst was for composite adverse perinatal outcome, with areas under the summary ROC curves of 0.90 and 0.66, respectively. The corresponding positive and negative likelihood ratios were 16.5 and 0.6 for perinatal mortality and 2.82 and 0.65 for composite adverse perinatal outcome, respectively. Following an abnormal vs normal uterine artery Doppler assessment, the posterior risks for composite adverse perinatal outcome, admission to the neonatal intensive care unit, Cesarean section for intrapartum fetal compromise, 5-min Apgar score < 7, neonatal acidosis and perinatal death were: 52.3% vs 20.2%, 48.6% vs 18.7%, 23.1% vs 15.2%, 3.59% vs 1.32%, 9.15% vs 5.12% and 31.4% vs 1.64%, respectively.Conclusion Abnormal uterine artery Doppler in the third trimester appears to be moderately useful in predicting perinatal death in pregnancies with suspected SGA.

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Third‐trimester uterine artery Doppler for prediction of adverse outcome in late small‐for‐gestational‐age fetuses: systematic review and meta‐analysis

Martinez‐Portilla

Caradeux

Meler

et al. 2020

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“…Furthermore, the mixture of low‐ and high‐risk pregnancies may have a negative effect on prediction rates for adverse perinatal outcome. Other studies have shown improved performance in fetuses with suboptimal growth and a more advanced gestational age with a shorter interval to delivery. Therefore, we included only low‐risk pregnancies for the calculation of aCPR‐MoM and analyzed a subgroup of pregnancies with the last ultrasound ≥ 34 weeks and within 4 weeks of delivery.…”

Section: Discussionmentioning

confidence: 99%

Prediction of adverse perinatal outcome by cerebroplacental ratio adjusted for estimated fetal weight

Sirico

Diemert

Glosemeyer

et al. 2018

“…and delivery 36 . EFW < 3 rd centile 37 , uterine artery Doppler 38,39 and biochemical markers such as placental growth factor 40 have also been used.…”

Section: Tablementioning

confidence: 99%

Using fetal abdominal circumference growth velocity in the prediction of adverse outcome in near‐term small‐for‐gestational‐age fetuses

Cavallaro

Veglia

Svirko

et al. 2018