Prediction of fetal growth restriction using estimated fetal weight <i>vs</i> a combined screening model in the third trimester

Miranda, Jezid; Rodríguez-López, Mérida; Triunfo, Stefania; Sairanen, Mikko; Kouru, Heikki; Parra‐Saavedra, Miguel; Crovetto, F.; Figueras, F.; Crispi, F.; Gratacós, E.

doi:10.1002/uog.17393

Cited by 49 publications

(42 citation statements)

References 51 publications

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“…Despite advances in antenatal care, the search for a test to identify the fetus at risk for intrauterine demise continues. The cerebroplacental ratio (CPR), a marker of brain sparing, is emerging as a predictor of adverse perinatal outcome, fetal growth restriction (FGR), neonatal care unit admission, intrapartum fetal compromise, episodes of recurrent reduced fetal movements, postnatal circulatory problems and perinatal death in near-term fetuses [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] . Low CPR reflects redistribution of the cardiac output to the brain and has been shown to improve the accuracy of predicting adverse outcome, as compared with middle cerebral artery (MCA) or umbilical artery (UA) Doppler alone [19][20][21][22][23] .…”

Section: Introductionmentioning

confidence: 99%

Longitudinal change in cerebroplacental ratio in small‐for‐gestational‐age fetuses and risk of stillbirth

Kalafat

Öztürk

Sivanathan

et al. 2019

Ultrasound in Obstet & Gyne

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Objective To investigate whether assessment of longitudinal change in Doppler variables in small‐for‐gestational‐age (SGA) fetuses improves the prediction of those at risk of stillbirth. Methods This was a longitudinal study of two cohorts of singleton pregnancies, which included SGA and appropriate‐for‐gestational‐age (AGA) fetuses, respectively. The inclusion criteria for the SGA cohort were singleton pregnancy at ≥ 20 weeks' gestation, classified as SGA (estimated fetal weight < 10th centile). The AGA cohort consisted of singleton pregnancies deemed at high risk of being SGA, which were followed up longitudinally but remained AGA. Fetal middle cerebral artery (MCA) pulsatility index (PI) and umbilical artery (UA)‐PI were measured longitudinally and cerebroplacental ratio (CPR) was calculated, and values were converted to multiples of the median. The last two measurements prior to delivery were included in the analysis. Longitudinal models for Doppler variables were developed using linear‐mixed models and their accuracy in the prediction of stillbirth was tested using generalized linear models. A Bayesian framework was employed to compare the accuracy of longitudinal and standard (last‐scan measurement) models. Results In total, 1549 AGA and 941 SGA pregnancies were included in the analysis. There were 30 (3.2%) and no stillbirth cases in the SGA and AGA groups, respectively. Change in MCA‐PI, UA‐PI and CPR with advancing gestation was significantly different between liveborn AGA and SGA fetuses, with a less pronounced difference with advancing gestation. Using the last measurement, the best models for the prediction of stillbirth in SGA pregnancies were those based on CPR (accuracy, 75.0%; 95% CI, 72.6–77.2%) and UA‐PI (accuracy, 71.0%; 95% CI, 68.6–73.4%). The posterior probability of the standard CPR model having a higher accuracy compared with the UA‐PI model was 97.2% (magnitude of change (MC), 3.9%; 95% credible interval (CrI), 0.5–7.3%). The accuracies of the standard, compared with the longitudinal, models for UA‐PI (71.0% vs 72.8%), MCA‐PI (64.6% vs 63.8%) and CPR (75.0% vs 74.9%) in the prediction of stillbirth were not significantly different. The posterior probabilities for improvement in accuracy using longitudinal, compared with standard, assessment were 50.1% (MC, < 0.1%; 95% CrI, −3.3 to 3.3%), 35.2% (MC, −0.1%; 95% CrI, −4.5 to 2.8%) and 82.2% (MC, 1.9%; 95% CrI, −1.5 to 5.3%) for CPR, MCA‐PI and UA‐PI models, respectively. Therefore, change in Doppler parameters did not improve the accuracy of the prediction of stillbirth, compared with that of the last‐scan measurement. Conclusion Longitudinal assessment of Doppler parameters was not useful in improving the detection of stillbirth in SGA pregnancies, as compared with a single‐point assessment. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

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Section: Introductionmentioning

confidence: 99%

Longitudinal change in cerebroplacental ratio in small‐for‐gestational‐age fetuses and risk of stillbirth

Kalafat

Öztürk

Sivanathan

et al. 2019

Ultrasound in Obstet & Gyne

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“…However, late FGR is difficult to diagnose 3 . So far, there are only limited data regarding screening for, and detection of, fetuses at risk for developing late FGR [4][5][6][7][8] .…”

Section: Introductionmentioning

confidence: 99%

First‐trimester and combined first‐ and second‐trimester prediction of small‐for‐gestational age and late fetal growth restriction

Sotiriadis

Figueras

Eleftheriades

et al. 2018

Ultrasound in Obstet & Gyne

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“…Sotiriadis et al (10) and the DR of 64% reported by J. Miranda et al (13) when using maternal characteristics and third-trimester EFW percentiles. F. Crovetto et al (14) used a combination of maternal risk factors, the first-trimester MAP, the mean UtA-PI and the soluble Fms-like tyrosine kinase-1 (sFlt-1)/placental growth factor (PLGF) ratio and detected 66% of cases of late-onset FGR, at a 10% FPR.…”

Section: Discussionmentioning

confidence: 98%

“…However, we acknowledge that there were some limitations in our study. First, given the nature of the retrospective design, data pertaining to many meaningful parameters, such as previous history of FGR, UtA-PI, PLGF and sFlt-1, which have high contributions to the prediction of FGR (13,14,26), were unavailable in the present study; otherwise, the detection rate would have been higher. Thus, we attempt to add the test of UtA-PI in pregnant women from the first trimester throughout the third trimester to further improve the detection rate of late FGR.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have assessed the performance of prenatal screening, with the combination of maternal characteristics, fetal biometry, Doppler parameters and biochemical markers, for the detection of FGR (10)(11)(12)(13)(14). Although they showed improved performance in the identification of early onset FGR, these models remained unsatisfactory for late-onset FGR.…”

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confidence: 99%

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Prediction of late-onset fetal growth restriction using a combined first- and second-trimester screening model in South Chinese infants: a retrospective study

Zheng

Feng

Zhang

et al. 2020

Preprint

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Background: Prediction models for early and late fetal growth restriction (FGR) have been established in many high-income countries. However, prediction models for late FGR in China are limited. This study aimed to develop a simple combined first- and second-trimester prediction model for screening late-onset FGR in South Chinese infants. Methods: This retrospective study included 2258 women who had singleton pregnancies and received routine ultrasound scans as training dataset. A validation dataset including 565 pregnant women was used to evaluate the model in order to enable an unbiased estimation. Late-onset FGR was defined as a birth weight < the 10th percentile plus abnormal Doppler indices and/or a birth weight below the 3rd percentile after 32 weeks, regardless of the Doppler status. Multivariate logistic regression was used to develop a prediction model. The model included the a priori risk (maternal characteristics), the second-trimester head circumference (HC/AC) / abdomen circumference (HC) ratio and estimated fetal weight (EFW). Results: Ninety-three fetuses were identified as late-onset FGR. The significant predictors for late-onset FGR were maternal age, height, weight, and medical history; the second-trimester HC/ AC ratio; and the EFW. This model achieved a detection rate (DR) of 52.6% for late-onset FGR at a 10% false positive rate (FPR) (area under the curve (AUC): 0.80, 95%CI 0.76-0.85). The AUC of the validation dataset was 0.65 (95%CI 0.54-0.78). Conclusions: A multivariate model combining first- and second-trimester default tests can detect 52.6% of cases of late-onset FGR at a 10% FPR. Further studies with more screening markers are needed to improve the detection rate.

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Prediction of fetal growth restriction using estimated fetal weight vs a combined screening model in the third trimester

Cited by 49 publications

References 51 publications

Longitudinal change in cerebroplacental ratio in small‐for‐gestational‐age fetuses and risk of stillbirth

Longitudinal change in cerebroplacental ratio in small‐for‐gestational‐age fetuses and risk of stillbirth

First‐trimester and combined first‐ and second‐trimester prediction of small‐for‐gestational age and late fetal growth restriction

Prediction of late-onset fetal growth restriction using a combined first- and second-trimester screening model in South Chinese infants: a retrospective study

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