11.
Prediction of fetal growth restriction using estimated fetal weight vs a combined screening model in the third trimester
Miranda, J.; Rodriguez‐Lopez, M.; Triunfo, S. ...
Ultrasound in obstetrics & gynecology,
November 2017, 2017-Nov, 2017-11-00, 20171101, Volume:
50, Issue:
5
Journal Article
ABSTRACT
Objectives
To compare the performance of third‐trimester screening, based on estimated fetal weight centile (EFWc) vs a combined model including maternal baseline characteristics, ...
fetoplacental ultrasound and maternal biochemical markers, for the prediction of small‐for‐gestational‐age (SGA) neonates and late‐onset fetal growth restriction (FGR).
Methods
This was a nested case–control study within a prospective cohort of 1590 singleton gestations undergoing third‐trimester (32 + 0 to 36 + 6 weeks' gestation) evaluation. Maternal baseline characteristics, mean arterial pressure, fetoplacental ultrasound and circulating biochemical markers (placental growth factor (PlGF), lipocalin‐2, unconjugated estriol and inhibin A) were assessed in all women who subsequently delivered a SGA neonate (n = 175), defined as birth weight < 10th centile according to customized standards, and in a control group (n = 875). Among SGA cases, those with birth weight < 3rd centile and/or abnormal uterine artery pulsatility index (UtA‐PI) and/or abnormal cerebroplacental ratio (CPR) were classified as FGR. Logistic regression predictive models were developed for SGA and FGR, and their performance was compared with that obtained using EFWc alone.
Results
In SGA cases, EFWc, CPR Z‐score and maternal serum concentrations of unconjugated estriol and PlGF were significantly lower, while mean UtA‐PI Z‐score and lipocalin‐2 and inhibin A concentrations were significantly higher, compared with controls. Using EFWc alone, 52% (area under receiver–operating characteristics curve (AUC), 0.82 (95% CI, 0.77–0.85)) of SGA and 64% (AUC, 0.86 (95% CI, 0.81–0.91)) of FGR cases were predicted at a 10% false‐positive rate. A combined screening model including a‐priori risk (maternal characteristics), EFWc, UtA‐PI, PlGF and estriol (with lipocalin‐2 for SGA) achieved a detection rate of 61% (AUC, 0.86 (95% CI, 0.83–0.89)) for SGA cases and 77% (AUC, 0.92 (95% CI, 0.88–0.95)) for FGR. The combined model for the prediction of SGA and FGR performed significantly better than did using EFWc alone (P < 0.001 and P = 0.002, respectively).
Conclusions
A multivariable integrative model of maternal characteristics, fetoplacental ultrasound and maternal biochemical markers modestly improved the detection of SGA and FGR cases at 32–36 weeks' gestation when compared with screening based on EFWc alone. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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12.
Angiogenic factors vs Doppler surveillance in the prediction of adverse outcome among late‐pregnancy small‐for‐ gestational‐age fetuses
Lobmaier, S. M.; Figueras, F.; Mercade, I. ...
Ultrasound in obstetrics & gynecology,
20/May , Volume:
43, Issue:
5
Journal Article
ABSTRACT
Objectives
To compare the value of Doppler surveillance with maternal blood angiogenic factors at diagnosis for the prediction of adverse outcome in late‐pregnancy small‐for‐gestational‐age ...
(SGA) fetuses.
Methods
In a cohort of 198 SGA fetuses we evaluated the association of Doppler indices (mean uterine artery pulsatility index (UtA‐PI) and cerebroplacental ratio (CPR)) and angiogenic factors (maternal serum levels of soluble fms‐like tyrosine kinase‐1 (sFlt‐1) and placental growth factor (PlGF)) with the development of pre‐eclampsia and adverse perinatal outcome (operative delivery for non‐reassuring fetal status or neonatal metabolic acidosis).
Results
In SGA fetuses subsequently developing pre‐eclampsia, mean UtA‐PI (P < 0.001), sFlt‐1 MoM (P < 0.001) and sFlt‐1/PlGF MoM ratio (P < 0.001) were higher, while PlGF MoM was lower (P = 0.004). In SGA fetuses with adverse perinatal outcome, CPR (P < 0.002) and PlGF MoM (P < 0.001) were lower, and sFlt‐1/PlGF MoM ratio was higher (P = 0.001). For predicting pre‐eclampsia, the areas under the receiver–operating characteristics (ROC) curves for mean UtA‐PI, sFlt‐1 MoM and the combination of both were 0.852, 0.839 and 0.860, respectively. For adverse perinatal outcome, the areas under the ROC curves for CPR, PlGF MoM and the combination of both were 0.652, 0.656 and 0.684, respectively. The combination of Doppler indices and angiogenic factors did not significantly improve prediction of either pre‐eclampsia (P = 0.851) or adverse outcome (P = 0.579).
Conclusions
In SGA fetuses, angiogenic factors at diagnosis and follow‐up with Doppler ultrasound both predict adverse outcome with a similar performance. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.
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13.
Customized birthweight standards for a Spanish population
Figueras, F; Meler, E; Iraola, A ...
European journal of obstetrics & gynecology and reproductive biology,
01/2008, Volume:
136, Issue:
1
Journal Article
Abstract Objective To analyse the biological factors affecting birthweight and to derive customized birthweight standards for a Spanish population. Methods A retrospective cohort was created with all ...
the singleton pregnancies delivered at term and free of pathology in our Institution. Birthweight was modeled by multiple linear regression from maternal (ethnic origin, maternal height, booking weight, smoking, and parity), and fetal (gender, gestational age) characteristics. Results In addition to gestational age and sex, height, booking weight, ethnic origin, parity, and smoking all have significant and independent effects on birthweight. Women from East-Asia, Morocco and South-America had newborns on average 83 g, 74 g and 95 g heavier than White-European Spanish women. The effect of smoking was found to be dose-related. Conclusion We found the relative effect of the maternal and fetal characteristics to be very similar to that reported in previous studies. We report coefficients for ethnic groups that account for a sizeable proportion of the population composition of several European countries.
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14.
Fetal MRI insular cortical morphometry and its association with neurobehavior in late‐onset small‐for‐gestational‐age fetuses
Egaña‐Ugrinovic, G.; Sanz‐Cortes, M.; Figueras, F. ...
Ultrasound in obstetrics & gynecology,
September 2014, Volume:
44, Issue:
3
Journal Article
ABSTRACT
Objective
To evaluate insular cortical morphometry assessed by magnetic resonance imaging (MRI) in late‐onset small‐for‐gestational‐age (SGA) fetuses compared with controls, and its ...
association with neurobehavioral outcomes.
Methods
MRI was performed in 65 late‐onset SGA and 59 normally‐grown fetuses at 37 weeks' gestation. T2‐weighted half Fourier acquisition single‐shot turbo spin echo (HASTE) anatomical and diffusion‐weighted images were acquired. Insular cortical thickness, volume and fractional anisotropy values were assessed, and asymmetry indices were constructed. At 42 weeks of age, a Neonatal Behavioral Assessment Scale (NBAS) test was performed on the SGA neonates.
Results
Late‐onset SGA fetuses had significantly thinner insular cortical thickness and smaller insular cortical volume than did controls. SGA fetuses also presented a more pronounced left asymmetry in the posterior cortex and significantly lower fractional anisotropy values in the left insula. Insular measurements in the SGA group were significantly correlated with neurobehavior as assessed by NBAS scores.
Conclusions
Insular cortical morphometry was significantly different in late‐onset SGA fetuses and correlated with poorer neurobehavioral performance. These data support the impact of growth restriction on brain development and the potential value of cortical assessment as a biomarker of neurodevelopment in at‐risk fetuses. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd
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15.
16.
First‐trimester screening for early and late small‐for‐gestational‐age neonates using maternal serum biochemistry, blood pressure and uterine artery Doppler
Crovetto, F.; Crispi, F.; Scazzocchio, E. ...
Ultrasound in obstetrics & gynecology,
January 2014, Volume:
43, Issue:
1
Journal Article
ABSTRACT
OBJECTIVE
To assess the effectiveness of first‐trimester screening for early and late small‐for‐gestational‐age (SGA) neonates using maternal serum biochemistry, blood pressure and uterine ...
artery Doppler.
Methods
This was a prospective study of 4970 women with a singleton pregnancy who underwent routine first‐trimester screening between 2009 and 2011. A logistic regression‐based predictive model for SGA, defined as birth weight < 10th percentile, divided into early‐ or late‐onset based on gestational age at delivery before or after 34 weeks' gestation, was constructed. The model included maternal baseline characteristics: serum levels of pregnancy‐associated plasma protein‐A and free β‐human chorionic gonadotropin at 8–12 weeks and blood pressure and uterine artery Doppler at 11 + 0 to 13 + 6 weeks.
Results
The prevalence of early and late SGA was 0.6% and 7.9%, respectively. Association with pre‐eclampsia was 67% and 8%, respectively. At a false‐positive rate of 15%, the detection rate for early SGA was 73%; however it differed substantially for cases with and without pre‐eclampsia (90% vs 40%). For late SGA, at false‐positive rates of 15 and 50%, detection rates were 32% and 70%, respectively, and did not substantially differ between cases with and without pre‐eclampsia.
Conclusions
First‐trimester screening predicts early SGA mainly because of its strong association with pre‐eclampsia. Although prediction of late SGA was poorer, at a high false‐positive rate it might be considered as part of a first‐trimester strategy to select women requiring ultrasound assessment in the third trimester. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.
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17.
First‐trimester screening with specific algorithms for early‐ and late‐onset fetal growth restriction
Crovetto, F.; Triunfo, S.; Crispi, F. ...
Ultrasound in obstetrics & gynecology,
September 2016, 2016-Sep, 20160901, Volume:
48, Issue:
3
Journal Article
ABSTRACT
Objective
To develop optimal first‐trimester algorithms for the prediction of early and late fetal growth restriction (FGR).
Methods
This was a prospective cohort study of singleton ...
pregnancies undergoing first‐trimester screening. FGR was defined as an ultrasound estimated fetal weight < 10th percentile plus Doppler abnormalities or a birth weight < 3rd percentile. Logistic regression‐based predictive models were developed for predicting early and late FGR (cut‐off: delivery at 34 weeks). The model included the a‐priori risk (maternal characteristics), mean arterial pressure (MAP), uterine artery pulsatility index (UtA‐PI), placental growth factor (PlGF) and soluble fms‐like tyrosine kinase‐1 (sFlt‐1).
Results
Of the 9150 pregnancies included, 462 (5%) fetuses were growth restricted: 59 (0.6%) early and 403 (4.4%) late. Significant contributions to the prediction of early FGR were provided by black ethnicity, chronic hypertension, previous FGR, MAP, UtA‐PI, PlGF and sFlt‐1. The model achieved an overall detection rate (DR) of 86.4% for a 10% false‐positive rate (area under the receiver–operating characteristics curve (AUC): 0.93 (95% CI, 0.87–0.98)). The DR was 94.7% for FGR with pre‐eclampsia (PE) (64% of cases) and 71.4% for FGR without PE (36% of cases). For late FGR, significant contributions were provided by chronic hypertension, autoimmune disease, previous FGR, smoking status, nulliparity, MAP, UtA‐PI, PlGF and sFlt‐1. The model achieved a DR of 65.8% for a 10% false‐positive rate (AUC: 0.76 (95% CI, 0.73–0.80)). The DR was 70.2% for FGR with PE (12% of cases) and 63.5% for FGR without PE (88% of cases).
Conclusions
The optimal screening algorithm was different for early vs late FGR, supporting the concept that screening for FGR is better performed separately for the two clinical forms. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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18.
Performance of third‐trimester combined screening model for prediction of adverse perinatal outcome
Miranda, J.; Triunfo, S.; Rodriguez‐Lopez, M. ...
Ultrasound in obstetrics & gynecology,
September 2017, 2017-Sep, 2017-09-00, 20170901, Volume:
50, Issue:
3
Journal Article
ABSTRACT
Objective
To explore the potential value of third‐trimester combined screening for the prediction of adverse perinatal outcome (APO) in the general population and among ...
small‐for‐gestational‐age (SGA) fetuses.
Methods
This was a nested case–control study within a prospective cohort of 1590 singleton gestations undergoing third‐trimester evaluation (32 + 0 to 36 + 6 weeks' gestation). Maternal baseline characteristics, mean arterial blood pressure, fetoplacental ultrasound and circulating biochemical markers (placental growth factor (PlGF), lipocalin‐2, unconjugated estriol and inhibin A) were assessed in all women who subsequently had an APO (n = 148) and in a control group without perinatal complications (n = 902). APO was defined as the occurrence of stillbirth, umbilical artery cord blood pH < 7.15, 5‐min Apgar score < 7 or emergency operative delivery for fetal distress. Logistic regression models were developed for the prediction of APO in the general population and among SGA cases (defined as customized birth weight < 10th centile).
Results
The prevalence of APO was 9.3% in the general population and 27.4% among SGA cases. In the general population, a combined screening model including a‐priori risk (maternal characteristics), estimated fetal weight (EFW) centile, umbilical artery pulsatility index (UA‐PI), estriol and PlGF achieved a detection rate for APO of 26% (area under receiver–operating characteristics curve (AUC), 0.59 (95% CI, 0.54–0.65)), at a 10% false‐positive rate (FPR). Among SGA cases, a model including a‐priori risk, EFW centile, UA‐PI, cerebroplacental ratio, estriol and PlGF predicted 62% of APO (AUC, 0.86 (95% CI, 0.80–0.92)) at a FPR of 10%.
Conclusions
The use of fetal ultrasound and maternal biochemical markers at 32–36 weeks provides a poor prediction of APO in the general population. Although it remains limited, the performance of the screening model is improved when applied to fetuses with suboptimal fetal growth. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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19.
Longitudinal growth assessment for prediction of adverse perinatal outcome in fetuses suspected to be small‐for‐gestational age
Caradeux, J.; Eixarch, E.; Mazarico, E. ...
Ultrasound in obstetrics & gynecology,
September 2018, 2018-09-00, 20180901, Volume:
52, Issue:
3
Journal Article
ABSTRACT
Objective
Fetal growth restriction (FGR) is associated with an increased risk of adverse perinatal outcome. However, distinguishing this condition from small‐for‐gestational age (SGA) ...
remains elusive. A set of criteria has been proposed recently for such a purpose, including the degree of smallness, Doppler parameters and growth velocity. The aim of this study was to establish whether the use of growth velocity adds value to Doppler assessment in predicting adverse perinatal outcome among SGA‐suspected fetuses.
Methods
This was a prospective cohort study of consecutive singleton pregnancies with late (diagnosis ≥ 32.0 weeks) SGA (estimated fetal weight (EFW) < 10th centile). Longitudinal growth assessment was performed by calculation of EFW z‐velocity between diagnosis and last scan before delivery. Improvement in the association with and predictive performance of EFW z‐velocity for adverse perinatal outcome was compared against standard criteria of FGR evaluated before delivery (EFW < 3rd centile, abnormal uterine Doppler or abnormal cerebroplacental ratio).
Result
A total of 472 patients were evaluated prospectively for suspected SGA. Of these, 231 (48.9%) qualified as late FGR. Univariate analysis showed a significant trend towards higher frequency (14.5% vs 8.2%; P = 0.041) of EFW z‐velocity in the lowest decile in pregnancies with adverse perinatal outcome. Nonetheless, the addition of EFW z‐velocity improved neither the association with nor the predictive performance of standard criteria of FGR for adverse perinatal outcome.
Conclusions
Longitudinal assessment of fetal growth by means of EFW z‐velocity did not have any independent predictive value for adverse perinatal outcome when used in combination with Doppler in SGA‐suspected fetuses. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
RESUMEN
Evaluación del crecimiento longitudinal para la predicción de un resultado perinatal adverso en fetos con sospecha de ser pequeños para la edad gestacional
Objetivo
La restricción del crecimiento fetal (RCF) está asociada con un mayor riesgo de un resultado perinatal adverso. Sin embargo, sigue siendo difícil distinguir esta condición de los fetos pequeños para la edad gestacional (PEG). Recientemente se ha propuesto un conjunto de criterios para este fin, como el grado de pequeñez, los parámetros del Doppler y la velocidad de crecimiento. El objetivo de este estudio fue establecer si el uso de la rapidez de crecimiento agrega valor a la evaluación Doppler en la predicción de resultados perinatales adversos en los fetos en los que se sospecha que son PEG.
Métodos
Este fue un estudio de cohorte prospectivo de embarazos consecutivos con feto único con PEG tardía (diagnóstico ≥32.0 semanas; peso fetal estimado (PFE) <10o percentil). Se realizó la evaluación del crecimiento longitudinal mediante el cálculo de la velocidad z del PFE entre diagnósticos y la última ecografía antes del parto. La mejora en la asociación con la velocidad z del PFE y el desempeño predictivo del resultado perinatal adverso se comparó con respecto a los criterios estándar de la RCF evaluados antes del parto (PFE <3rd percentil, Doppler uterino anómalo o relación cerebroplacentaria anómala).
Resultados
Un total de 472 pacientes fueron evaluadas prospectivamente respecto a la sospecha de ser PEG. De estas, 231 (48.9%) calificaron como RCF tardío. El análisis univariante mostró una tendencia significativa hacia una mayor frecuencia (14,5% vs 8;2%; P =0,041) de la velocidad z del PFE en el decil más bajo en embarazos con resultados perinatales adversos. No obstante, el añadir la velocidad z del PFE no mejoró ni la asociación ni el desempeño predictivo de los criterios estándar de la RCF para el resultado perinatal adverso.
Conclusiones
La evaluación longitudinal del crecimiento fetal por medio de la velocidad z del PFE no tuvo un valor predictivo independiente del resultado perinatal adverso cuando se utilizó en combinación con el Doppler en fetos con sospecha de ser PEG.
摘要
通过纵向生长评估预测疑似小于胎龄儿的不良围产结局
目的
胎儿生长受限(fetal growth restriction,FGR)导致不良围产结局风险增加。然而,很难鉴别其与小于胎龄儿(small‐for‐gestational age,SGA)。因此,最近人们提出一系列标准,包括体重降低程度、多普勒超声参数和生长速度。本研究的目的是证实采用生长速度是否对多普勒超声评估预测疑似SGA胎儿的不良围产结局有益。
方法
本研究为前瞻性队列研究,纳入连续的迟发(≥32.0周确诊)SGA(估计胎儿体重estimated fetal weight,EFW<第10百分位数)单胎妊娠。通过计算确诊和分娩前最后一次超声检查间EFW z速度进行纵向生长评估。比较EFW z速度与分娩前评估的FGR公认标准相比,与不良围产结局的相关性以及预测能力的改善情况(EFW<第3百分位数,子宫多普勒超声异常或脑胎盘率异常)。
结果
共前瞻性评估472例疑似SGA的患者。其中231例(48.9%)为迟发FGR。单变量分析显示,在不良围产结局的妊娠中呈EFW z速度在最低十分位数的频率较高(14.5%和8.2%;P=0.041)的明显趋势。但是,采用EFW z速度既不能提高与不良围产结局的相关性,也不能提高FGR公认标准对不良围产结局的预测能力。
结论
在疑似SGA的胎儿中联合多普勒超声时,采用EFW z速度对胎儿生长进行纵向评估对不良围产结局无独立预测价值
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20.
Longitudinal changes in uterine, umbilical and fetal cerebral Doppler indices in late‐onset small‐for‐gestational age fetuses
Oros, D.; Figueras, F.; Cruz‐Martinez, R. ...
Ultrasound in obstetrics & gynecology,
February 2011, Volume:
37, Issue:
2
Journal Article
Objectives
To determine the longitudinal trends and rates of conversion of normal to abnormal uterine (UtA), umbilical (UA) and middle cerebral artery (MCA) Doppler velocimetry throughout the third ...
trimester in late‐onset small‐for‐gestational‐age (SGA) fetuses.
Methods
UtA, UA and MCA Doppler velocimetry was serially performed in a cohort of singleton consecutive late‐onset SGA fetuses with normal Doppler values at diagnosis. The rate of conversion of normal to abnormal Doppler values was evaluated by survival analysis. Longitudinal trends were modeled by means of multilevel analysis.
Results
A total of 616 scans were performed on 171 SGA fetuses. Mean gestational age at inclusion and at delivery was 34.1 (SD 1.6) and 38.7 (SD 1.7) weeks, respectively. The proportions of abnormal UtA (2.3 vs. 4.1%) and UA (2.3 vs. 2.9%) pulsatility index (PI) were not significantly different between 37 weeks and before delivery. On the other hand, the proportions of abnormal MCA‐PI (4.1 vs. 13.5%) and cerebroplacental ratio (CPR) (7 vs. 22.8%) were significantly different between these two examinations. The remaining proportion of cases with normal UtA‐, UA‐ and MCA‐PIs and CPR at 40 weeks were 98.6, 94.5, 85 and 49.6%, respectively. Whereas a slight increasing trend was observed for the UtA‐PI (β = 0.002) and UA‐PI (β = 0.01), MCA‐PI (β = 0.044) and CPR (β = 0.124) showed a progressive decrease until delivery.
Conclusions
Late‐onset SGA fetuses with normal Doppler velocimetry upon diagnosis show progression from 37 weeks' gestation with worsening CPR followed by a decrease in MCA‐PI. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.
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