Serial plotting on customised fundal height charts results in doubling of the antenatal detection of small for gestational age fetuses in nulliparous women

Roex, Alphonse; Nikpoor, Payam; Eerd, Eva van; Hodyl, Nicolette A.; Dekker, Gus

doi:10.1111/j.1479-828x.2011.01408.x

Cited by 36 publications

(36 citation statements)

References 12 publications

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“…A reduction in perinatal mortality in SGA infants late in pregnancy requires a combination of increased detection and optimal timing of birth. Increased antenatal detection of SGA can be achieved with implementation of customised antenatal growth charts in routine antenatal care 2. The recommendations from this article regarding the optimum timing of delivery (37–38 weeks) are consistent with data from other epidemiological studies which show an increase in SGA perinatal mortality after 37 weeks, with a particular increase after 38 weeks.…”

Section: Commentarysupporting

confidence: 80%

Small-for-gestational-age pregnancies are at cumulative increased risk of stillbirth for each week pregnancy continues beyond 37 weeks

McCowan

Chelimo

2014

Evid Based Nurs

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Commentary on: Trudell AS, Cahill AG, Tuuli MG, et al. Risk of stillbirth after 37 weeks in pregnancies complicated by small-for-gestational-age fetuses. Am J Obstet Gynecol 2013;208:376.e1-7. Implications for practice and research▪ This article could improve nurses' knowledge of the importance of small-for-gestational-age (SGA) pregnancies and of their substantial contribution to the burden of stillbirth. It also provides evidence as to why SGA pregnancies are delivered prior to full term.▪ Longer term outcomes for SGA children must be further investigated, as should maternal attitudes to timing of delivery. ContextSGA (usually defined as birth-weight <10th centile) affects approximately 10% of pregnancies. Approximately 40% of non-anomalous stillborn infants are SGA, comprising a major contribution to the global public health problem of stillbirth. 1 Optimising outcomes for SGA infants diagnosed before birth is affected by the competing risks of prematurity and, if pregnancy continues, late stillbirth. The aim of this study was to investigate weekly and cumulative stillbirth risk, beyond 37 weeks, in SGA pregnancies. This study included 3333 SGA and 47 053 non-SGA pregnancies from a Washington University perinatal database. MethodsThis retrospective cohort study was conducted using prospectively collected perinatal data. Data during pregnancy and at the time of delivery were entered by trained research nurses. The study population comprised all singleton pregnancies from 1990 to 2009 that were subject to an anatomy scan between 16 and 23 weeks of gestation, comprising 97% of the eligible study population. Any missing key data were obtained from the maternity care provider. The number of stillbirths per 10 000 ongoing pregnancies is reported for each week of gestation, as is the cumulative risk for each individual woman throughout the remainder of pregnancy. FindingsA twofold increase in stillbirth occurred in SGA pregnancies beyond 37 weeks versus those delivered at 37 weeks. The risk of SGA stillbirth increased significantly at 39 and 40 weeks. The risk of stillbirth in the 38th week was not significantly increased compared with 37 weeks, except in severely SGA infants (<5th centile). Perinatal morbidity reduced as gestation advanced in SGA survivors. The authors concluded that there is a significant increase in the cumulative probability of stillbirth in SGA pregnancies after 37 weeks and advocated delivery of SGA pregnancies at 37-38 weeks to minimise the risk of stillbirth. CommentaryIn current practice, the majority of SGA babies remain undetected before birth. A reduction in perinatal mortality in SGA infants late in pregnancy requires a combination of increased detection and optimal timing of birth. Increased antenatal detection of SGA can be achieved with implementation of customised antenatal growth charts in routine antenatal care. 2 The recommendations from this article regarding the optimum timing of delivery (37-38 weeks) are consistent with data from other epidemiological studies which show an in...

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Section: Commentarysupporting

confidence: 80%

Small-for-gestational-age pregnancies are at cumulative increased risk of stillbirth for each week pregnancy continues beyond 37 weeks

McCowan

Chelimo

2014

Evid Based Nurs

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“…12 SFH as a predictor of SGA may also be limited by the presence of fibroids, the contribution of amniotic fluid and descent of the presenting part in late pregnancy. Observational studies have reported that the use of customised fundal height charts can approximately double the detection of SGA, 13 although this has not yet been tested in randomised studies.…”

Section: Clinical Detection Of Late-onset Fgrmentioning

confidence: 99%

Shining light in dark corners: Diagnosis and management of late‐onset fetal growth restriction

MacDonald

McCarthy

Walker

2015

Aust NZ J Obst Gynaeco

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Fetal growth restriction (FGR) is the single biggest risk factor for stillbirth. In the absence of any effective treatment for fetal growth restriction, the mainstay of management is close surveillance and timely delivery. While such statements are almost self-evident, the daily clinical challenge of late-onset fetal growth restriction remains; the competing priorities of minimising stillbirth risk, while avoiding excessive obstetric intervention and the neonatal sequelae of iatrogenic preterm birth. This dilemma is made harder because the tools for late-onset FGR diagnosis and surveillance compare poorly to those used in early-onset FGR; screening tests in early pregnancy have limited predictive value; most cases escape clinical detection, a phenomenon set to worsen given the obesity epidemic; there is a failure of consensus on the definition of small for gestational age, and ancillary tools, such as umbilical artery Doppler--of value in identification of preterm FGR--are less useful in the late-preterm period and at term. Most importantly, the problem is common; 96% of all births occur after 32 weeks. This means a poor noise/signal ratio of any test or management algorithm will inevitably have large clinical consequences. Into such a dark corner, we cast some light; a summary on diagnostic criteria, new developments to improve the diagnosis of late-onset FGR and a suggested approach to management.

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“…FGR is defined as the inability of a fetus to reach its genetically determined growth potential (Kusinski, Stanley, Dilworth, Hirt, Andersson, Renshall, Baker et al 2012). Characteristics of FGR include reduced birth weight, abnormal placentation, fetal hypoglycaemia, hypoxia and increased fetal cortisol concentrations (Economides, Nicolaides, Campbell 1991 McCowan, Thompson, Taylor, North, Poston, Baker, Myers et al 2013) and 42 % of early neonatal deaths (Roex, Nikpoor, van Eerd, Hodyl, Dekker 2012) in the Western world. The metabolic changes associated with maternal obesity such as insulin resistance, hypertension, elevated triglycerides, increased systemic inflammatory profiles and oxidative stress can lead to placental insufficiency (Hajer, van Haeften, Visseren 2008;Huang, Yu, Keim, Li, Zhang, Zhang 2014) and mitochondrial abnormalities in the placenta (Mele, Muralimanoharan, Maloyan, Myatt 2014).…”

Section: Introductionmentioning

confidence: 99%

Maternal-fetal hepatic and placental metabolome profiles are associated with reduced fetal growth in a rat model of maternal obesity

et al. 2016

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Serial plotting on customised fundal height charts results in doubling of the antenatal detection of small for gestational age fetuses in nulliparous women

Abstract: Serial plotting of the FH on customised charts supported by a clinical practice guideline resulted in a doubling of the antenatal detection of SGA in nulliparous pregnant women at low risk for SGA.

Cited by 36 publications

References 12 publications

Small-for-gestational-age pregnancies are at cumulative increased risk of stillbirth for each week pregnancy continues beyond 37 weeks

Small-for-gestational-age pregnancies are at cumulative increased risk of stillbirth for each week pregnancy continues beyond 37 weeks

Shining light in dark corners: Diagnosis and management of late‐onset fetal growth restriction

Maternal-fetal hepatic and placental metabolome profiles are associated with reduced fetal growth in a rat model of maternal obesity

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