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Contingent versus routine third‐trimester screening for late fetal growth restriction
Triunfo, S.; Crovetto, F.; Scazzocchio, E. ...
Ultrasound in obstetrics & gynecology,
January 2016, 2016-Jan, 2016-01-00, 20160101, Volume:
47, Issue:
1
Journal Article
Peer reviewed
Open access
ABSTRACT
Objective
To evaluate the use of third‐trimester ultrasound screening for late fetal growth restriction (FGR) on a contingent basis, according to risk accrued in the second trimester, in an ...
unselected population.
Methods
Maternal characteristics, fetal biometry and second‐trimester uterine artery (UtA) Doppler were included in logistic regression analysis to estimate risk for late FGR (birth weight < 3rd percentile, or 3rd–10th percentile plus abnormal cerebroplacental ratio or UtA Doppler, with delivery ≥ 34 weeks). Based on the second‐trimester risk, strategies for performing contingent third‐trimester ultrasound examinations in 10%, 25% or 50% of the cohort were tested against a strategy of routine ultrasound scanning in the entire population at 32 + 0 to 33 + 6 weeks.
Results
Models were constructed based on 1393 patients and validated in 1303 patients, including 73 (5.2%) and 82 late FGR (6.3%) cases, respectively. At the second‐trimester scan, the a‐posteriori second‐trimester risk (a‐posteriori first‐trimester risk (baseline a‐priori risk and mean arterial blood pressure) combined with second‐trimester abdominal circumference and UtA Doppler) yielded an area under the receiver–operating characteristics curve (AUC) of 0.81 (95% CI, 0.74–0.87) (detection rate (DR), 43.1% for a 10% false‐positive rate (FPR)). The combination of a‐posteriori second‐trimester risk plus third‐trimester estimated fetal weight (full model) yielded an AUC of 0.92 (95% CI, 0.88–0.96) (DR, 74% for a 10% FPR). Subjecting 10%, 25% or 50% of the study population to third‐trimester ultrasound, based on a‐posteriori second‐trimester risk, gave AUCs of 0.81 (95% CI, 0.75–0.88), 0.84 (95% CI, 0.78–0.91) and 0.89 (95% CI, 0.84–0.94), respectively. Only the 50% contingent model proved statistically equivalent to performing routine third‐trimester ultrasound scans (AUC, 0.92 (95% CI, 0.88–0.96), P = 0.11).
Conclusion
A strategy of selecting 50% of the study population to undergo third‐trimester ultrasound examination, based on accrued risk in the second trimester, proved equivalent to routine third‐trimester ultrasound scanning in predicting late FGR. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Added value of umbilical vein flow as a predictor of perinatal outcome in term small‐for‐gestational‐age fetuses
Parra‐Saavedra, M.; Crovetto, F.; Triunfo, S. ...
Ultrasound in obstetrics & gynecology,
August 2013, 2013-Aug, 2013-08-00, 20130801, Volume:
42, Issue:
2
Journal Article
Peer reviewed
Open access
ABSTRACT
Objective
To compare umbilical vein (UV) flow with standard Doppler parameters in prediction of adverse perinatal outcome in late‐onset small‐for‐gestational age (SGA) fetuses.
Methods
...
Umbilical, uterine and middle cerebral arteries, and UV blood flow were evaluated by Doppler before delivery in a cohort of 193 term SGA fetuses. The value of the Doppler parameters to predict risk of emergency delivery for non‐reassuring fetal status and neonatal metabolic acidosis was analyzed.
Results
Fifty‐three (27%) fetuses had non‐reassuring fetal status requiring emergency delivery, whereas 21 (11%) newborns developed neonatal metabolic acidosis. Multivariable analysis showed that significant contributions to prediction of emergency delivery for non‐reassuring fetal status and neonatal metabolic acidosis were provided by middle cerebral artery (MCA) pulsatility index (PI) and UV blood flow normalized by fetal weight. Decision tree analysis defined three groups with increasing risk of need for emergency delivery for non‐reassuring fetal status: MCA‐PI > 1.46 (risk 15.6%); MCA‐PI ≤ 1.46 and UV blood flow > 68 mL/min/kg (risk 25%); and MCA‐PI ≤ 1.46 and UV flow ≤ 68 mL/min/kg (risk 53.1%); and two groups with different risks of neonatal metabolic acidosis: UV flow > 68 mL/min/kg or UV flow ≤ 68 mL/min/kg and MCA‐PI > 1.23 (risk ≤ 10%); and UV flow ≤ 68 mL/min/kg and MCA‐PI ≤ 1.23 (risk 39.1%).
Conclusion
The evaluation of UV blood flow with spectral brain Doppler allows better identification of SGA fetuses with late‐onset intrauterine growth restriction at risk of adverse perinatal outcome. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.
Linked Comment: Ultrasound Obstet Gynecol 2013:42:130
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