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Routine ultrasound at 32 vs 36 weeks' gestation: prediction of small-for-gestational-age neonates.
Ultrasound Obstet Gynecol. 2019 Jun; 53(6):761-768.UO

Abstract

OBJECTIVE

To evaluate and compare the performance of routine ultrasonographic estimated fetal weight (EFW) and fetal abdominal circumference (AC) at 31 + 0 to 33 + 6 and 35 + 0 to 36 + 6 weeks' gestation in the prediction of a small-for-gestational-age (SGA) neonate.

METHODS

This was a prospective study of 21 989 singleton pregnancies undergoing routine ultrasound examination at 31 + 0 to 33 + 6 weeks' gestation and 45 847 undergoing routine ultrasound examination at 35 + 0 to 36 + 6 weeks' gestation. In each case, the estimated fetal weight (EFW) from measurements of fetal head circumference, AC and femur length was calculated using the Hadlock formula and expressed as a percentile according to The Fetal Medicine Foundation fetal and neonatal population weight charts. The same charts were used for defining a SGA neonate with birth weight < 10th and < 3rd percentiles. For each gestational-age window, the screen-positive and detection rates, at different EFW percentile cut-offs between the 10th and 50th percentiles, were calculated for prediction of delivery of a SGA neonate with birth weight < 10th and < 3rd percentiles within 2 weeks and at any stage after assessment. The areas under the receiver-operating characteristics curves (AUC) in screening for a SGA neonate by EFW and AC at 31 + 0 to 33 + 6 and at 35 + 0 to 36 + 6 weeks' gestation were compared.

RESULTS

First, the AUCs in screening by EFW for a SGA neonate with birth weight < 10th and < 3rd percentiles delivered within 2 weeks and at any stage after screening at 35 + 0 to 36 + 6 weeks' gestation were significantly higher than those at 31 + 0 to 33 + 6 weeks (P < 0.001). Second, at both 35 + 0 to 36 + 6 and 31 + 0 to 33 + 6 weeks' gestation, the predictive performance for a SGA neonate with birth weight < 10th and < 3rd percentiles born at any stage after screening was significantly higher using EFW Z-score than AC Z-score. Similarly, at 35 + 0 to 36 + 6 weeks, but not at 31 + 0 to 33 + 6 weeks, the predictive performance for a SGA neonate with birth weight < 10th and < 3rd percentiles born within 2 weeks after screening was significantly higher using EFW Z-score than AC Z-score. Third, screening by EFW < 10th percentile at 35 + 0 to 36 + 6 weeks' gestation predicted 70% and 84% of neonates with birth weight < 10th and < 3rd percentiles, respectively, born within 2 weeks after assessment, and the respective values for a neonate born at any stage after assessment were 46% and 65%. Fourth, prediction of > 85% of SGA neonates with birth weight < 10th percentile born at any stage after screening at 35 + 0 to 36 + 6 weeks' gestation requires use of EFW < 40th percentile. Screening at this percentile cut-off predicted 95% and 99% of neonates with birth weight < 10th and < 3rd percentiles, respectively, born within 2 weeks after assessment, and the respective values for a neonate born at any stage after assessment were 87% and 94%.

CONCLUSIONS

The predictive performance for a SGA neonate of routine ultrasonographic examination during the third trimester is higher if, first, the scan is carried out at 35 + 0 to 36 + 6 weeks' gestation than at 31 + 0 to 33 + 6 weeks, second, the method of screening is EFW than fetal AC, third, the outcome measure is birth weight < 3rd than < 10th percentile, and, fourth, if delivery occurs within 2 weeks than at any stage after assessment. Prediction of a SGA neonate by EFW < 10th percentile is modest and prediction of > 85% of cases at 35 + 0 to 36 + 6 weeks' gestation necessitates use of EFW < 40th percentile. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Authors+Show Affiliations

Fetal Medicine Research Institute, King's College Hospital, London, UK.Fetal Medicine Unit, Medway Maritime Hospital, Gillingham, UK. Institute of Medical Sciences, Canterbury Christ Church University, Chatham, UK.Fetal Medicine Research Institute, King's College Hospital, London, UK.Fetal Medicine Unit, Medway Maritime Hospital, Gillingham, UK. Institute of Medical Sciences, Canterbury Christ Church University, Chatham, UK.Fetal Medicine Research Institute, King's College Hospital, London, UK.

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

30883981

Citation

Ciobanu, A, et al. "Routine Ultrasound at 32 Vs 36 Weeks' Gestation: Prediction of Small-for-gestational-age Neonates." Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology, vol. 53, no. 6, 2019, pp. 761-768.
Ciobanu A, Khan N, Syngelaki A, et al. Routine ultrasound at 32 vs 36 weeks' gestation: prediction of small-for-gestational-age neonates. Ultrasound Obstet Gynecol. 2019;53(6):761-768.
Ciobanu, A., Khan, N., Syngelaki, A., Akolekar, R., & Nicolaides, K. H. (2019). Routine ultrasound at 32 vs 36 weeks' gestation: prediction of small-for-gestational-age neonates. Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology, 53(6), 761-768. https://doi.org/10.1002/uog.20258
Ciobanu A, et al. Routine Ultrasound at 32 Vs 36 Weeks' Gestation: Prediction of Small-for-gestational-age Neonates. Ultrasound Obstet Gynecol. 2019;53(6):761-768. PubMed PMID: 30883981.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Routine ultrasound at 32 vs 36 weeks' gestation: prediction of small-for-gestational-age neonates. AU - Ciobanu,A, AU - Khan,N, AU - Syngelaki,A, AU - Akolekar,R, AU - Nicolaides,K H, Y1 - 2019/04/30/ PY - 2019/02/25/received PY - 2019/03/04/revised PY - 2019/03/08/accepted PY - 2019/3/19/pubmed PY - 2020/1/7/medline PY - 2019/3/19/entrez KW - adverse perinatal outcome KW - estimated fetal weight KW - fetal biometry KW - pyramid of pregnancy care KW - small-for-gestational age KW - symphysis-fundus height KW - third-trimester screening SP - 761 EP - 768 JF - Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology JO - Ultrasound Obstet Gynecol VL - 53 IS - 6 N2 - OBJECTIVE: To evaluate and compare the performance of routine ultrasonographic estimated fetal weight (EFW) and fetal abdominal circumference (AC) at 31 + 0 to 33 + 6 and 35 + 0 to 36 + 6 weeks' gestation in the prediction of a small-for-gestational-age (SGA) neonate. METHODS: This was a prospective study of 21 989 singleton pregnancies undergoing routine ultrasound examination at 31 + 0 to 33 + 6 weeks' gestation and 45 847 undergoing routine ultrasound examination at 35 + 0 to 36 + 6 weeks' gestation. In each case, the estimated fetal weight (EFW) from measurements of fetal head circumference, AC and femur length was calculated using the Hadlock formula and expressed as a percentile according to The Fetal Medicine Foundation fetal and neonatal population weight charts. The same charts were used for defining a SGA neonate with birth weight < 10th and < 3rd percentiles. For each gestational-age window, the screen-positive and detection rates, at different EFW percentile cut-offs between the 10th and 50th percentiles, were calculated for prediction of delivery of a SGA neonate with birth weight < 10th and < 3rd percentiles within 2 weeks and at any stage after assessment. The areas under the receiver-operating characteristics curves (AUC) in screening for a SGA neonate by EFW and AC at 31 + 0 to 33 + 6 and at 35 + 0 to 36 + 6 weeks' gestation were compared. RESULTS: First, the AUCs in screening by EFW for a SGA neonate with birth weight < 10th and < 3rd percentiles delivered within 2 weeks and at any stage after screening at 35 + 0 to 36 + 6 weeks' gestation were significantly higher than those at 31 + 0 to 33 + 6 weeks (P < 0.001). Second, at both 35 + 0 to 36 + 6 and 31 + 0 to 33 + 6 weeks' gestation, the predictive performance for a SGA neonate with birth weight < 10th and < 3rd percentiles born at any stage after screening was significantly higher using EFW Z-score than AC Z-score. Similarly, at 35 + 0 to 36 + 6 weeks, but not at 31 + 0 to 33 + 6 weeks, the predictive performance for a SGA neonate with birth weight < 10th and < 3rd percentiles born within 2 weeks after screening was significantly higher using EFW Z-score than AC Z-score. Third, screening by EFW < 10th percentile at 35 + 0 to 36 + 6 weeks' gestation predicted 70% and 84% of neonates with birth weight < 10th and < 3rd percentiles, respectively, born within 2 weeks after assessment, and the respective values for a neonate born at any stage after assessment were 46% and 65%. Fourth, prediction of > 85% of SGA neonates with birth weight < 10th percentile born at any stage after screening at 35 + 0 to 36 + 6 weeks' gestation requires use of EFW < 40th percentile. Screening at this percentile cut-off predicted 95% and 99% of neonates with birth weight < 10th and < 3rd percentiles, respectively, born within 2 weeks after assessment, and the respective values for a neonate born at any stage after assessment were 87% and 94%. CONCLUSIONS: The predictive performance for a SGA neonate of routine ultrasonographic examination during the third trimester is higher if, first, the scan is carried out at 35 + 0 to 36 + 6 weeks' gestation than at 31 + 0 to 33 + 6 weeks, second, the method of screening is EFW than fetal AC, third, the outcome measure is birth weight < 3rd than < 10th percentile, and, fourth, if delivery occurs within 2 weeks than at any stage after assessment. Prediction of a SGA neonate by EFW < 10th percentile is modest and prediction of > 85% of cases at 35 + 0 to 36 + 6 weeks' gestation necessitates use of EFW < 40th percentile. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd. SN - 1469-0705 UR - https://www.unboundmedicine.com/medline/citation/30883981/Routine_ultrasound_at_32_vs_36_weeks'_gestation:_prediction_of_small_for_gestational_age_neonates_ L2 - https://doi.org/10.1002/uog.20258 DB - PRIME DP - Unbound Medicine ER -