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Significance and Outcomes of Fetal Growth Restriction Below the 5th Percentile Compared to the 5th to 10th Percentiles on Midgestation Growth Ultrasonography.
J Ultrasound Med. 2018 Sep; 37(9):2243-2249.JU

Abstract

OBJECTIVE

To determine whether there are differences in neonatal and pregnancy outcomes in pregnancies complicated by severe fetal growth restriction, defined as estimated fetal weight below the 5th percentile, compared with estimated fetal weight in the 5th to 10th percentiles at midgestation.

METHODS

We conducted a retrospective review of singleton nonanomalous gestations with estimated fetal weight at or below the 10th percentile (Hadlock et al. Radiology 1991; 181:129-133) at 18 to 24 weeks' gestation. The cohort was divided into fetuses with estimated fetal weight below the 5th percentile and estimated fetal weight in the 5th to 10th percentiles. Antenatal and neonatal outcomes were compared across the groups.

RESULTS

Of the 254 growth-restricted fetuses, 91 had estimated fetal weight below the 5th percentile, and 163 were in the 5th to 10th percentiles. Fetuses below the 5th percentile were 2.82 times more likely to be born small for gestational age compared to fetuses at the 5th to 10th percentiles (P = .001). Fetuses with estimated fetal weight below the 5th percentile had higher rates of hypertensive disorders of pregnancy (relative risk [RR], 1.79; P = .04), abnormal umbilical artery Doppler waveforms (RR, 6.27; P = .01), labor induction (RR, 1.45; P = .002), neonatal intensive care unit admission (RR, 1.73; P = .02), and Apgar scores of less than 7 at 1 minute (RR, 2.05; P = .04).

CONCLUSIONS

Severely growth-restricted fetuses with an estimated fetal weight below the 5th percentile at 18 to 24 weeks are born smaller and have worse antepartum and neonatal outcomes than those with an estimated fetal weight in the 5th to 10th percentiles. These findings suggest that severely growth-restricted fetuses at midgestation should be treated and counseled differently than those in the 5th to 10th percentiles.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

29476559

Citation

Zhang-Rutledge, Kathy, et al. "Significance and Outcomes of Fetal Growth Restriction Below the 5th Percentile Compared to the 5th to 10th Percentiles On Midgestation Growth Ultrasonography." Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine, vol. 37, no. 9, 2018, pp. 2243-2249.
Zhang-Rutledge K, Mack LM, Mastrobattista JM, et al. Significance and Outcomes of Fetal Growth Restriction Below the 5th Percentile Compared to the 5th to 10th Percentiles on Midgestation Growth Ultrasonography. J Ultrasound Med. 2018;37(9):2243-2249.
Zhang-Rutledge, K., Mack, L. M., Mastrobattista, J. M., & Gandhi, M. (2018). Significance and Outcomes of Fetal Growth Restriction Below the 5th Percentile Compared to the 5th to 10th Percentiles on Midgestation Growth Ultrasonography. Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine, 37(9), 2243-2249. https://doi.org/10.1002/jum.14577
Zhang-Rutledge K, et al. Significance and Outcomes of Fetal Growth Restriction Below the 5th Percentile Compared to the 5th to 10th Percentiles On Midgestation Growth Ultrasonography. J Ultrasound Med. 2018;37(9):2243-2249. PubMed PMID: 29476559.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Significance and Outcomes of Fetal Growth Restriction Below the 5th Percentile Compared to the 5th to 10th Percentiles on Midgestation Growth Ultrasonography. AU - Zhang-Rutledge,Kathy, AU - Mack,Lauren M, AU - Mastrobattista,Joan M, AU - Gandhi,Manisha, Y1 - 2018/02/24/ PY - 2017/06/27/received PY - 2017/11/15/revised PY - 2017/12/04/accepted PY - 2018/2/25/pubmed PY - 2019/1/17/medline PY - 2018/2/25/entrez KW - antenatal outcomes KW - fetal growth restriction KW - neonatal outcomes KW - obstetrics KW - small for gestational age SP - 2243 EP - 2249 JF - Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine JO - J Ultrasound Med VL - 37 IS - 9 N2 - OBJECTIVE: To determine whether there are differences in neonatal and pregnancy outcomes in pregnancies complicated by severe fetal growth restriction, defined as estimated fetal weight below the 5th percentile, compared with estimated fetal weight in the 5th to 10th percentiles at midgestation. METHODS: We conducted a retrospective review of singleton nonanomalous gestations with estimated fetal weight at or below the 10th percentile (Hadlock et al. Radiology 1991; 181:129-133) at 18 to 24 weeks' gestation. The cohort was divided into fetuses with estimated fetal weight below the 5th percentile and estimated fetal weight in the 5th to 10th percentiles. Antenatal and neonatal outcomes were compared across the groups. RESULTS: Of the 254 growth-restricted fetuses, 91 had estimated fetal weight below the 5th percentile, and 163 were in the 5th to 10th percentiles. Fetuses below the 5th percentile were 2.82 times more likely to be born small for gestational age compared to fetuses at the 5th to 10th percentiles (P = .001). Fetuses with estimated fetal weight below the 5th percentile had higher rates of hypertensive disorders of pregnancy (relative risk [RR], 1.79; P = .04), abnormal umbilical artery Doppler waveforms (RR, 6.27; P = .01), labor induction (RR, 1.45; P = .002), neonatal intensive care unit admission (RR, 1.73; P = .02), and Apgar scores of less than 7 at 1 minute (RR, 2.05; P = .04). CONCLUSIONS: Severely growth-restricted fetuses with an estimated fetal weight below the 5th percentile at 18 to 24 weeks are born smaller and have worse antepartum and neonatal outcomes than those with an estimated fetal weight in the 5th to 10th percentiles. These findings suggest that severely growth-restricted fetuses at midgestation should be treated and counseled differently than those in the 5th to 10th percentiles. SN - 1550-9613 UR - https://www.unboundmedicine.com/medline/citation/29476559/Significance_and_Outcomes_of_Fetal_Growth_Restriction_Below_the_5th_Percentile_Compared_to_the_5th_to_10th_Percentiles_on_Midgestation_Growth_Ultrasonography_ L2 - https://doi.org/10.1002/jum.14577 DB - PRIME DP - Unbound Medicine ER -