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Prediction of small-for-gestational-age neonates: screening by uterine artery Doppler and mean arterial pressure at 19-24 weeks.
Ultrasound Obstet Gynecol. 2015 Sep; 46(3):332-40.UO

Abstract

OBJECTIVE

To investigate the potential value of uterine artery (UtA) pulsatility index (PI) and mean arterial pressure (MAP) at 19-24 weeks' gestation, in combination with maternal characteristics and medical history and fetal biometry in the prediction of delivery of small-for-gestational-age (SGA) neonates in the absence of pre-eclampsia (PE) and to examine the potential value of such assessment in deciding whether the third-trimester scan should be performed at 32 and/or 36 weeks' gestation.

METHODS

This was a screening study in 63 975 singleton pregnancies, including 3702 (5.8%) that delivered SGA neonates with birth weight < 5(th) percentile (SGA < 5(th)) in the absence of PE. Multivariable logistic regression analysis was used to determine if screening by a combination of maternal factors, fetal head circumference (HC), abdominal circumference (AC), femur length (FL), UtA-PI and MAP had significant contribution in predicting SGA neonates. A model was developed to select gestational age for the third-trimester assessment, at 32 and/or 36 weeks, based on the results of screening at 19-24 weeks.

RESULTS

The detection rates (DRs) of combined screening by maternal factors, fetal biometry and UtA-PI at 19-24 weeks were 90%, 68% and 44% for SGA < 5(th) delivering < 32, 32-36 and ≥ 37 weeks' gestation, respectively, at a false-positive rate (FPR) of 10%. The performance of screening was not improved by the addition of MAP. The DR of SGA < 5(th) delivering at 32-36 weeks improved from 68% to 90% with screening at 32 rather than at 19-24 weeks. Similarly, the DR of SGA < 5(th) delivering ≥ 37 weeks improved from 44% with screening at 19-24 weeks to 59% and 76% when screening at 32 and 36 weeks, respectively. In a hypothetical model, it was estimated that if the desired objective of prenatal screening is to predict about 80% of the cases of SGA < 5(th) , it would be necessary to select 17% of the population at the 19-24-week assessment to be reassessed at 32 weeks and 38% to be reassessed at 36 weeks; 62% would not require a third-trimester scan.

CONCLUSION

Prenatal prediction of a high proportion of SGA neonates necessitates the undertaking of screening in the third trimester of pregnancy in addition to assessment in the second trimester, and the timing of such screening, at 32 and/or 36 weeks, should be contingent on the results of the assessment at 19-24 weeks.

Authors+Show Affiliations

Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

25810352

Citation

Lesmes, C, et al. "Prediction of Small-for-gestational-age Neonates: Screening By Uterine Artery Doppler and Mean Arterial Pressure at 19-24 Weeks." Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology, vol. 46, no. 3, 2015, pp. 332-40.
Lesmes C, Gallo DM, Saiid Y, et al. Prediction of small-for-gestational-age neonates: screening by uterine artery Doppler and mean arterial pressure at 19-24 weeks. Ultrasound Obstet Gynecol. 2015;46(3):332-40.
Lesmes, C., Gallo, D. M., Saiid, Y., Poon, L. C., & Nicolaides, K. H. (2015). Prediction of small-for-gestational-age neonates: screening by uterine artery Doppler and mean arterial pressure at 19-24 weeks. Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology, 46(3), 332-40. https://doi.org/10.1002/uog.14855
Lesmes C, et al. Prediction of Small-for-gestational-age Neonates: Screening By Uterine Artery Doppler and Mean Arterial Pressure at 19-24 Weeks. Ultrasound Obstet Gynecol. 2015;46(3):332-40. PubMed PMID: 25810352.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prediction of small-for-gestational-age neonates: screening by uterine artery Doppler and mean arterial pressure at 19-24 weeks. AU - Lesmes,C, AU - Gallo,D M, AU - Saiid,Y, AU - Poon,L C, AU - Nicolaides,K H, Y1 - 2015/08/06/ PY - 2015/03/17/accepted PY - 2015/3/27/entrez PY - 2015/3/27/pubmed PY - 2016/6/22/medline KW - mean arterial pressure KW - pre-eclampsia KW - pyramid of antenatal care KW - second-trimester screening KW - small-for-gestational age KW - uterine artery Doppler SP - 332 EP - 40 JF - Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology JO - Ultrasound Obstet Gynecol VL - 46 IS - 3 N2 - OBJECTIVE: To investigate the potential value of uterine artery (UtA) pulsatility index (PI) and mean arterial pressure (MAP) at 19-24 weeks' gestation, in combination with maternal characteristics and medical history and fetal biometry in the prediction of delivery of small-for-gestational-age (SGA) neonates in the absence of pre-eclampsia (PE) and to examine the potential value of such assessment in deciding whether the third-trimester scan should be performed at 32 and/or 36 weeks' gestation. METHODS: This was a screening study in 63 975 singleton pregnancies, including 3702 (5.8%) that delivered SGA neonates with birth weight < 5(th) percentile (SGA < 5(th)) in the absence of PE. Multivariable logistic regression analysis was used to determine if screening by a combination of maternal factors, fetal head circumference (HC), abdominal circumference (AC), femur length (FL), UtA-PI and MAP had significant contribution in predicting SGA neonates. A model was developed to select gestational age for the third-trimester assessment, at 32 and/or 36 weeks, based on the results of screening at 19-24 weeks. RESULTS: The detection rates (DRs) of combined screening by maternal factors, fetal biometry and UtA-PI at 19-24 weeks were 90%, 68% and 44% for SGA < 5(th) delivering < 32, 32-36 and ≥ 37 weeks' gestation, respectively, at a false-positive rate (FPR) of 10%. The performance of screening was not improved by the addition of MAP. The DR of SGA < 5(th) delivering at 32-36 weeks improved from 68% to 90% with screening at 32 rather than at 19-24 weeks. Similarly, the DR of SGA < 5(th) delivering ≥ 37 weeks improved from 44% with screening at 19-24 weeks to 59% and 76% when screening at 32 and 36 weeks, respectively. In a hypothetical model, it was estimated that if the desired objective of prenatal screening is to predict about 80% of the cases of SGA < 5(th) , it would be necessary to select 17% of the population at the 19-24-week assessment to be reassessed at 32 weeks and 38% to be reassessed at 36 weeks; 62% would not require a third-trimester scan. CONCLUSION: Prenatal prediction of a high proportion of SGA neonates necessitates the undertaking of screening in the third trimester of pregnancy in addition to assessment in the second trimester, and the timing of such screening, at 32 and/or 36 weeks, should be contingent on the results of the assessment at 19-24 weeks. SN - 1469-0705 UR - https://www.unboundmedicine.com/medline/citation/25810352/Prediction_of_small_for_gestational_age_neonates:_screening_by_uterine_artery_Doppler_and_mean_arterial_pressure_at_19_24_weeks_ L2 - https://doi.org/10.1002/uog.14855 DB - PRIME DP - Unbound Medicine ER -