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Preventing term stillbirth: benefits and limitations of using fetal growth reference charts.
Curr Opin Obstet Gynecol 2019; 31(6):365-374CO

Abstract

PURPOSE OF REVIEW

This review examines the variation in clinical practice with regards to ultrasound estimation of fetal weight, as well as calculation of fetal weight centiles.

RECENT FINDINGS

Placental dysfunction is associated with fetal smallness from intrauterine malnutrition as well as fetal disability and even stillbirth from hypoxemia. Although estimating fetal weight can be done accurately, the issue of which fetal weight centile chart should be used continues to be a contentious topic. The arguments against local fetal growth charts based on national borders and customization for variables known to be associated with disease are substantial. As for other human diseases such as hypertension and diabetes, there is a rationale for the use of an international fetal growth reference standard. Irrespective of the choice of fetal growth reference standard, a significant limitation of small for gestational age (SGA) detection programs to prevent stillbirth is that the majority of stillborn infants at term were not SGA at the time of demise.

SUMMARY

Placental dysfunction can present with SGA from malnutrition and/or stillbirth from hypoxemia depending on the gestational age of onset. Emerging data show that at term, fetal Doppler arterial redistribution is associated more strongly with perinatal death than fetal size. Properly conducted trials of the role for maternal characteristics, fetal size, placental biomarkers, and Doppler assessing fetal well-being are required urgently.

Authors+Show Affiliations

Department of Obstetrics and Gynaecology, St. George Hospital University Medical Center, Beirut, Lebanon. Department of Obstetrics and Gynaecology, FMU, Spirito Santo Tertiary Level Hospital of Pescara, Pescara, Italy. Department of Obstetrics and Gynaecology, Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, United Kingdom.Department of Obstetrics and Gynaecology, St. George Hospital University Medical Center, Beirut, Lebanon. Department of Obstetrics and Gynaecology, FMU, Spirito Santo Tertiary Level Hospital of Pescara, Pescara, Italy. Department of Obstetrics and Gynaecology, Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, United Kingdom.Department of Obstetrics and Gynaecology, St. George Hospital University Medical Center, Beirut, Lebanon. Department of Obstetrics and Gynaecology, FMU, Spirito Santo Tertiary Level Hospital of Pescara, Pescara, Italy. Department of Obstetrics and Gynaecology, Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, United Kingdom.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31634162

Citation

Halimeh, Rawad, et al. "Preventing Term Stillbirth: Benefits and Limitations of Using Fetal Growth Reference Charts." Current Opinion in Obstetrics & Gynecology, vol. 31, no. 6, 2019, pp. 365-374.
Halimeh R, Melchiorre K, Thilaganathan B. Preventing term stillbirth: benefits and limitations of using fetal growth reference charts. Curr Opin Obstet Gynecol. 2019;31(6):365-374.
Halimeh, R., Melchiorre, K., & Thilaganathan, B. (2019). Preventing term stillbirth: benefits and limitations of using fetal growth reference charts. Current Opinion in Obstetrics & Gynecology, 31(6), pp. 365-374. doi:10.1097/GCO.0000000000000576.
Halimeh R, Melchiorre K, Thilaganathan B. Preventing Term Stillbirth: Benefits and Limitations of Using Fetal Growth Reference Charts. Curr Opin Obstet Gynecol. 2019;31(6):365-374. PubMed PMID: 31634162.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preventing term stillbirth: benefits and limitations of using fetal growth reference charts. AU - Halimeh,Rawad, AU - Melchiorre,Karen, AU - Thilaganathan,Basky, PY - 2019/10/22/pubmed PY - 2019/10/22/medline PY - 2019/10/22/entrez SP - 365 EP - 374 JF - Current opinion in obstetrics & gynecology JO - Curr. Opin. Obstet. Gynecol. VL - 31 IS - 6 N2 - PURPOSE OF REVIEW: This review examines the variation in clinical practice with regards to ultrasound estimation of fetal weight, as well as calculation of fetal weight centiles. RECENT FINDINGS: Placental dysfunction is associated with fetal smallness from intrauterine malnutrition as well as fetal disability and even stillbirth from hypoxemia. Although estimating fetal weight can be done accurately, the issue of which fetal weight centile chart should be used continues to be a contentious topic. The arguments against local fetal growth charts based on national borders and customization for variables known to be associated with disease are substantial. As for other human diseases such as hypertension and diabetes, there is a rationale for the use of an international fetal growth reference standard. Irrespective of the choice of fetal growth reference standard, a significant limitation of small for gestational age (SGA) detection programs to prevent stillbirth is that the majority of stillborn infants at term were not SGA at the time of demise. SUMMARY: Placental dysfunction can present with SGA from malnutrition and/or stillbirth from hypoxemia depending on the gestational age of onset. Emerging data show that at term, fetal Doppler arterial redistribution is associated more strongly with perinatal death than fetal size. Properly conducted trials of the role for maternal characteristics, fetal size, placental biomarkers, and Doppler assessing fetal well-being are required urgently. SN - 1473-656X UR - https://www.unboundmedicine.com/medline/citation/31634162/Preventing_term_stillbirth:_benefits_and_limitations_of_using_fetal_growth_reference_charts L2 - http://dx.doi.org/10.1097/GCO.0000000000000576 DB - PRIME DP - Unbound Medicine ER -