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Fetal Echocardiography and Pulsed-wave Doppler Ultrasound in a Rabbit Model of Intrauterine Growth Restriction
Published on: June 29, 2013
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First-trimester screening with specific algorithms for early- and late-onset fetal growth restriction
F Crovetto1,2, S Triunfo1, F Crispi1
1BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
Summary
This study developed distinct first-trimester screening algorithms for early and late fetal growth restriction (FGR). Tailored prediction models improve early detection of FGR, enhancing prenatal care.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Diagnostic Ultrasound
Background:
- Fetal growth restriction (FGR) is a major cause of perinatal morbidity and mortality.
- Current first-trimester screening methods for FGR lack optimal predictive accuracy.
- Developing distinct algorithms for early and late FGR is crucial for timely intervention.
Purpose of the Study:
- To create optimized first-trimester prediction algorithms for early and late fetal growth restriction (FGR).
- To evaluate the efficacy of maternal characteristics, mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), placental growth factor (PlGF), and soluble fms-like tyrosine kinase-1 (sFlt-1) in FGR prediction.
Main Methods:
- A prospective cohort study involving 9150 singleton pregnancies undergoing first-trimester screening.
- FGR defined by ultrasound-estimated fetal weight <10th percentile with Doppler abnormalities or birth weight <3rd percentile.
- Logistic regression models incorporating maternal factors, MAP, UtA-PI, PlGF, and sFlt-1 were developed.
Main Results:
- Early FGR (0.6%) prediction model achieved 86.4% detection rate (DR) at 10% false-positive rate (FPR) (AUC: 0.93).
- Late FGR (4.4%) prediction model achieved 65.8% DR at 10% FPR (AUC: 0.76).
- Prediction accuracy varied for FGR with and without pre-eclampsia (PE) for both early and late FGR.
Conclusions:
- Distinct screening algorithms are optimal for early versus late fetal growth restriction.
- Separate screening approaches for early and late FGR support clinical differentiation and management.
- These findings can inform the development of more effective first-trimester FGR screening protocols.
