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Definitions matter: detection rates and perinatal outcome for infants classified prenatally as having late fetal growth restriction using SMFM biometric vs ISUOG/Delphi consensus criteria.
Ultrasound Obstet Gynecol. 2023 Mar; 61(3):377-385.UO

Abstract

OBJECTIVES

Fetal growth restriction (FGR) is often secondary to placental dysfunction and is suspected prenatally based on biometric or circulatory abnormalities detected on ultrasound. The aims of this study were to compare the screening performance of the Society for Maternal-Fetal Medicine (SMFM) biometric criteria (estimated fetal weight (EFW) or abdominal circumference (AC) < 10th centile) with that of the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG)-endorsed Delphi consensus criteria for late FGR for delivery of a small-for-gestational-age (SGA) infant at term, emergency Cesarean section (CS) for non-reassuring fetal status (NRFS), perinatal mortality and composite severe neonatal morbidity.

METHODS

We classified retrospectively non-anomalous singleton infants as having late FGR (diagnosed ≥ 32 weeks) according to SMFM and ISUOG/Delphi criteria in a cohort of women who had been referred to the Mater Mother's Hospital, Brisbane, Australia and who delivered at term between January 2014 and December 2020. The study outcomes were delivery of a SGA infant (birth weight (BW) < 10th or < 3rd centile), emergency CS for NRFS, perinatal mortality (defined as stillbirth or neonatal death within 28 days of a live birth) and a composite of severe neonatal morbidity. We assessed the screening performance of various ultrasound variables by calculating the sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, false-positive and false-negative rates, positive likelihood ratio (LR+) and negative likelihood ratio.

RESULTS

The SMFM and ISUOG/Delphi consensus criteria collectively classified 1030 cases as having late FGR. Of these, 400 cases were classified by both SMFM and ISUOG/Delphi criteria, whilst 548 cases were classified using only SMFM criteria and 82 cases were classified only by ISUOG/Delphi criteria. Prenatal detection of late FGR by SMFM and ISUOG/Delphi criteria was associated with increased odds of delivery of an infant with BW < 10th centile (SMFM: adjusted odds ratio (aOR), 133.0 (95% CI, 94.7-186.6); ISUOG/Delphi: aOR, 69.5 (95% CI, 49.1-98.2)) or BW < 3rd centile (SMFM: aOR, 348.7 (95% CI, 242.6-501.2); ISUOG/Delphi: aOR, 215.4 (95% CI, 148.4-312.7)). Compared with the SMFM criteria, the ISUOG/Delphi criteria were associated with lower odds (aOR, 0.5 (95% CI, 0.3-0.8)) of predicting a SGA infant with BW < 10th centile, but higher odds of predicting emergency CS for NRFS (aOR, 2.30 (95% CI, 1.14-4.66)) and composite neonatal morbidity (aOR, 1.22 (95% CI, 1.05-1.41)). Both SMFM and ISUOG/Delphi criteria were associated with high LR+, specificity, PPV and NPV for the prediction of infants with BW < 10th and BW < 3rd centile. However, both methods functioned much less efficiently for the prediction of composite severe neonatal morbidity or emergency CS for NRFS, with LR+ < 10. The SMFM biometric criteria alone, particularly AC < 3rd centile, had the highest LR+ values for the prediction of perinatal mortality.

CONCLUSION

Both the SMFM and ISUOG/Delphi criteria had strong screening potential for the detection of infants with BW < 10th or < 3rd centile but not for adverse neonatal outcome. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Schreiber V
Mater Research Institute, The University of Queensland, South Brisbane, Queensland, Australia. Faculty of Medicine, The University of Queensland, South Brisbane, Queensland, Australia.
Hurst C
Queensland Institute of Medical Research, Brisbane, Queensland, Australia.
da Silva Costa F
Maternal Fetal Medicine Unit, Gold Coast University Hospital and School of Medicine, Griffith University, Gold Coast, Queensland, Australia.
Stoke R
Mater Research Institute, The University of Queensland, South Brisbane, Queensland, Australia. Faculty of Medicine, The University of Queensland, South Brisbane, Queensland, Australia.
Turner J
Mater Research Institute, The University of Queensland, South Brisbane, Queensland, Australia. Faculty of Medicine, The University of Queensland, South Brisbane, Queensland, Australia.
Kumar S
Mater Research Institute, The University of Queensland, South Brisbane, Queensland, Australia. Faculty of Medicine, The University of Queensland, South Brisbane, Queensland, Australia. Centre for Maternal and Fetal Medicine, Mater Mother's Hospital, Brisbane, Queensland, Australia. NHMRC Centre for Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, South Brisbane, Queensland, Australia.

MeSH

Infant, NewbornPregnancyInfantFemaleHumansFetal Growth RetardationCesarean SectionRetrospective StudiesPerinatologyDelphi TechniquePlacentaUltrasonography, PrenatalInfant, Small for Gestational AgeBirth WeightFetal WeightPerinatal DeathBiometryGestational Age

Pub Type(s)

Journal Article

Language

eng

PubMed ID

35866888

Citation

Schreiber, V, et al. "Definitions Matter: Detection Rates and Perinatal Outcome for Infants Classified Prenatally as Having Late Fetal Growth Restriction Using SMFM Biometric Vs ISUOG/Delphi Consensus Criteria." Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology, vol. 61, no. 3, 2023, pp. 377-385.
Schreiber V, Hurst C, da Silva Costa F, et al. Definitions matter: detection rates and perinatal outcome for infants classified prenatally as having late fetal growth restriction using SMFM biometric vs ISUOG/Delphi consensus criteria. Ultrasound Obstet Gynecol. 2023;61(3):377-385.
Schreiber, V., Hurst, C., da Silva Costa, F., Stoke, R., Turner, J., & Kumar, S. (2023). Definitions matter: detection rates and perinatal outcome for infants classified prenatally as having late fetal growth restriction using SMFM biometric vs ISUOG/Delphi consensus criteria. Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology, 61(3), 377-385. https://doi.org/10.1002/uog.26035
Schreiber V, et al. Definitions Matter: Detection Rates and Perinatal Outcome for Infants Classified Prenatally as Having Late Fetal Growth Restriction Using SMFM Biometric Vs ISUOG/Delphi Consensus Criteria. Ultrasound Obstet Gynecol. 2023;61(3):377-385. PubMed PMID: 35866888.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Definitions matter: detection rates and perinatal outcome for infants classified prenatally as having late fetal growth restriction using SMFM biometric vs ISUOG/Delphi consensus criteria. AU - Schreiber,V, AU - Hurst,C, AU - da Silva Costa,F, AU - Stoke,R, AU - Turner,J, AU - Kumar,S, PY - 2022/6/22/revised PY - 2022/2/7/received PY - 2022/7/14/accepted PY - 2022/7/23/pubmed PY - 2023/3/3/medline PY - 2022/7/22/entrez KW - Doppler KW - cerebroplacental ratio KW - fetal growth restriction KW - middle cerebral artery Doppler KW - perinatal mortality KW - pregnancy KW - small-for-gestational age KW - stillbirth KW - umbilical artery Doppler SP - 377 EP - 385 JF - Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology JO - Ultrasound Obstet Gynecol VL - 61 IS - 3 N2 - OBJECTIVES: Fetal growth restriction (FGR) is often secondary to placental dysfunction and is suspected prenatally based on biometric or circulatory abnormalities detected on ultrasound. The aims of this study were to compare the screening performance of the Society for Maternal-Fetal Medicine (SMFM) biometric criteria (estimated fetal weight (EFW) or abdominal circumference (AC) < 10th centile) with that of the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG)-endorsed Delphi consensus criteria for late FGR for delivery of a small-for-gestational-age (SGA) infant at term, emergency Cesarean section (CS) for non-reassuring fetal status (NRFS), perinatal mortality and composite severe neonatal morbidity. METHODS: We classified retrospectively non-anomalous singleton infants as having late FGR (diagnosed ≥ 32 weeks) according to SMFM and ISUOG/Delphi criteria in a cohort of women who had been referred to the Mater Mother's Hospital, Brisbane, Australia and who delivered at term between January 2014 and December 2020. The study outcomes were delivery of a SGA infant (birth weight (BW) < 10th or < 3rd centile), emergency CS for NRFS, perinatal mortality (defined as stillbirth or neonatal death within 28 days of a live birth) and a composite of severe neonatal morbidity. We assessed the screening performance of various ultrasound variables by calculating the sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, false-positive and false-negative rates, positive likelihood ratio (LR+) and negative likelihood ratio. RESULTS: The SMFM and ISUOG/Delphi consensus criteria collectively classified 1030 cases as having late FGR. Of these, 400 cases were classified by both SMFM and ISUOG/Delphi criteria, whilst 548 cases were classified using only SMFM criteria and 82 cases were classified only by ISUOG/Delphi criteria. Prenatal detection of late FGR by SMFM and ISUOG/Delphi criteria was associated with increased odds of delivery of an infant with BW < 10th centile (SMFM: adjusted odds ratio (aOR), 133.0 (95% CI, 94.7-186.6); ISUOG/Delphi: aOR, 69.5 (95% CI, 49.1-98.2)) or BW < 3rd centile (SMFM: aOR, 348.7 (95% CI, 242.6-501.2); ISUOG/Delphi: aOR, 215.4 (95% CI, 148.4-312.7)). Compared with the SMFM criteria, the ISUOG/Delphi criteria were associated with lower odds (aOR, 0.5 (95% CI, 0.3-0.8)) of predicting a SGA infant with BW < 10th centile, but higher odds of predicting emergency CS for NRFS (aOR, 2.30 (95% CI, 1.14-4.66)) and composite neonatal morbidity (aOR, 1.22 (95% CI, 1.05-1.41)). Both SMFM and ISUOG/Delphi criteria were associated with high LR+, specificity, PPV and NPV for the prediction of infants with BW < 10th and BW < 3rd centile. However, both methods functioned much less efficiently for the prediction of composite severe neonatal morbidity or emergency CS for NRFS, with LR+ < 10. The SMFM biometric criteria alone, particularly AC < 3rd centile, had the highest LR+ values for the prediction of perinatal mortality. CONCLUSION: Both the SMFM and ISUOG/Delphi criteria had strong screening potential for the detection of infants with BW < 10th or < 3rd centile but not for adverse neonatal outcome. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. SN - 1469-0705 UR - https://www.unboundmedicine.com/medline/citation/35866888/Definitions_matter:_detection_rates_and_perinatal_outcome_for_infants_classified_prenatally_as_having_late_fetal_growth_restriction_using_SMFM_biometric_vs_ISUOG/Delphi_consensus_criteria_ DB - PRIME DP - Unbound Medicine ER -