Severe smallness as predictor of adverse perinatal outcome in suspected late small‐for‐gestational‐age fetuses: systematic review and meta‐analysis

Abstract

What are the novel findings of this work?Although suspected severe small-for-gestational age (SGA), defined as estimated fetal weight or abdominal circumference < 3 rd percentile or < 2 SD, is associated with a higher risk of perinatal complications, it performs poorly as a standalone parameter in predicting adverse perinatal outcome. The predictive performance of suspected severe SGA is similar to the individual performance of fetal cerebral Doppler and uterine artery Doppler parameters, as reported in the literature. The combination of these parameters may improve the overall prediction of abnormal perinatal outcome. What are the clinical implications of this work?Suspected severe SGA is not an accurate standalone predictor of adverse perinatal outcome. Given that severe SGA and abnormal Doppler parameters may reflect different pathological pathways, their combination could improve the overall prediction of abnormal perinatal outcome. A complete fetal examination incorporating fetal biometry and uterine artery and fetal Doppler evaluation should be performed when assessing for SGA.

Comparison of ductus venosus Doppler and cerebroplacental ratio for the prediction of adverse perinatal outcome in high‐risk pregnancies before and after 34 weeks

“…This is in line with recent reports describing EFW as a poor APO determinant, especially when is taken as a standalone parameter. 41 In this regard, and despite the CPR MoM supremacy, the best prediction is probably achieved combining the information provided by both ultrasound parameters.…”

Small babies, big risks: global estimates of prevalence and mortality for vulnerable newborns to accelerate change and improve counting

“…Since short length of gestation is the strongest predictor of mortality risk and longer term adverse neurodevelopmental outcomes, (45,65), splitting the preterm categories into subgroups based on maturity could provide useful additional information for both policy and programming and individual care. Further categorisations of severity of SGA e.g., <3 rd centile could be informative (66). Whilst the smallest newborns have the highest mortality risk, large for gestational age (LGA) is increasing in prevalence and may in some settings be associated with an increase in risk; it could also be included to provide a more complete overview (64).…”

Prenatal prediction of adverse outcome using different charts and definitions of fetal growth restriction

“…Our data support the findings of Choi et al 37 , since neither prescriptive nor descriptive charts for fetal growth assessment improved the performance of FGR definitions. The question of how to distinguish between normal and pathological growth before birth remains unsolved by choosing different definitions and growth charts 38 .…”