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Mid-pregnancy fetal growth, uteroplacental Doppler indices and maternal demographic characteristics: role in prediction of stillbirth.
Acta Obstet Gynecol Scand 2016; 95(11):1313-1318AO

Abstract

INTRODUCTION

To evaluate the relative value of mid trimester fetal growth, uterine artery Doppler indices and maternal demographics in prediction of stillbirth.

MATERIAL AND METHODS

Retrospective cohort study; 23 894 singleton pregnancies routinely scanned between 19 and 24 weeks' gestation. Maternal characteristics included age, body mass index, ethnicity and medical history. Fetal biometry indices, birthweight and uterine artery pulsatility index values were converted to percentiles and multivariable logistic regression analysis was performed. The predictive accuracy was assessed using receiver operating characteristic curves analysis. The main outcome was prediction of preterm and term stillbirths.

RESULTS

Non-Caucasian ethnicity, femur length centile and uterine artery pulsatility index were significantly associated with the risk of stillbirth (all p < 0.01). The detection rate of screening by maternal factors alone was 19% for all stillbirths, and 12 and 14% for term and preterm stillbirth at a 10% false positive rate, respectively. Using femur length centile alone, the detection rates were 27 and 23%, respectively. Uterine artery pulsatility index alone was able to predict 24 and 31% of term and preterm stillbirths. Screening by combining maternal factors, femur length centile and uterine artery Doppler detected 27 and 35% of term and preterm stillbirths at a 10% false positive rate.

CONCLUSIONS

Second trimester ultrasound assessment offers an opportunity to identify pregnancies at the highest risk of stillbirth occurring as a consequence of placental dysfunction. This information may be useful to improve pregnancy outcome by identifying women who may benefit from increased ultrasound surveillance and/or timely intervention.

Authors+Show Affiliations

Fetal Medicine Unit, Academic Department of Obstetrics and Gynecology, St George's University of London, London, UK. familiari.ale@gmail.com.Fetal Medicine Unit, Academic Department of Obstetrics and Gynecology, St George's University of London, London, UK.Fetal Medicine Unit, Academic Department of Obstetrics and Gynecology, St George's University of London, London, UK.Fetal Medicine Unit, Academic Department of Obstetrics and Gynecology, St George's University of London, London, UK.Fetal Medicine Unit, Academic Department of Obstetrics and Gynecology, St George's University of London, London, UK.Fetal Medicine Unit, Academic Department of Obstetrics and Gynecology, St George's University of London, London, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27588413

Citation

Familiari, Alessandra, et al. "Mid-pregnancy Fetal Growth, Uteroplacental Doppler Indices and Maternal Demographic Characteristics: Role in Prediction of Stillbirth." Acta Obstetricia Et Gynecologica Scandinavica, vol. 95, no. 11, 2016, pp. 1313-1318.
Familiari A, Scala C, Morlando M, et al. Mid-pregnancy fetal growth, uteroplacental Doppler indices and maternal demographic characteristics: role in prediction of stillbirth. Acta Obstet Gynecol Scand. 2016;95(11):1313-1318.
Familiari, A., Scala, C., Morlando, M., Bhide, A., Khalil, A., & Thilaganathan, B. (2016). Mid-pregnancy fetal growth, uteroplacental Doppler indices and maternal demographic characteristics: role in prediction of stillbirth. Acta Obstetricia Et Gynecologica Scandinavica, 95(11), pp. 1313-1318. doi:10.1111/aogs.13012.
Familiari A, et al. Mid-pregnancy Fetal Growth, Uteroplacental Doppler Indices and Maternal Demographic Characteristics: Role in Prediction of Stillbirth. Acta Obstet Gynecol Scand. 2016;95(11):1313-1318. PubMed PMID: 27588413.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mid-pregnancy fetal growth, uteroplacental Doppler indices and maternal demographic characteristics: role in prediction of stillbirth. AU - Familiari,Alessandra, AU - Scala,Carolina, AU - Morlando,Maddalena, AU - Bhide,Amar, AU - Khalil,Asma, AU - Thilaganathan,Basky, PY - 2016/02/08/received PY - 2016/08/29/accepted PY - 2016/10/21/pubmed PY - 2017/2/18/medline PY - 2016/9/3/entrez KW - Second trimester screening KW - femur length KW - fetal biometry KW - stillbirth KW - uterine artery Dopplers SP - 1313 EP - 1318 JF - Acta obstetricia et gynecologica Scandinavica JO - Acta Obstet Gynecol Scand VL - 95 IS - 11 N2 - INTRODUCTION: To evaluate the relative value of mid trimester fetal growth, uterine artery Doppler indices and maternal demographics in prediction of stillbirth. MATERIAL AND METHODS: Retrospective cohort study; 23 894 singleton pregnancies routinely scanned between 19 and 24 weeks' gestation. Maternal characteristics included age, body mass index, ethnicity and medical history. Fetal biometry indices, birthweight and uterine artery pulsatility index values were converted to percentiles and multivariable logistic regression analysis was performed. The predictive accuracy was assessed using receiver operating characteristic curves analysis. The main outcome was prediction of preterm and term stillbirths. RESULTS: Non-Caucasian ethnicity, femur length centile and uterine artery pulsatility index were significantly associated with the risk of stillbirth (all p < 0.01). The detection rate of screening by maternal factors alone was 19% for all stillbirths, and 12 and 14% for term and preterm stillbirth at a 10% false positive rate, respectively. Using femur length centile alone, the detection rates were 27 and 23%, respectively. Uterine artery pulsatility index alone was able to predict 24 and 31% of term and preterm stillbirths. Screening by combining maternal factors, femur length centile and uterine artery Doppler detected 27 and 35% of term and preterm stillbirths at a 10% false positive rate. CONCLUSIONS: Second trimester ultrasound assessment offers an opportunity to identify pregnancies at the highest risk of stillbirth occurring as a consequence of placental dysfunction. This information may be useful to improve pregnancy outcome by identifying women who may benefit from increased ultrasound surveillance and/or timely intervention. SN - 1600-0412 UR - https://www.unboundmedicine.com/medline/citation/27588413/Mid_pregnancy_fetal_growth_uteroplacental_Doppler_indices_and_maternal_demographic_characteristics:_role_in_prediction_of_stillbirth_ L2 - https://doi.org/10.1111/aogs.13012 DB - PRIME DP - Unbound Medicine ER -