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Routine ultrasound screening for antenatal detection of intrauterine growth retardation
Insights
Ultrasonic biometry effectively screens for intrauterine growth retardation (IUGR). Abdominal circumference measurements at 34 weeks gestation offer the best detection rates for this condition.
Area of Science:
- Obstetrics and Gynecology
- Medical Imaging
- Fetal Medicine
Background:
- Intrauterine growth retardation (IUGR) is a significant concern in pregnancy.
- Early and accurate diagnosis of IUGR is crucial for optimal fetal outcomes.
- Ultrasonic biometry is a common tool for fetal assessment during pregnancy.
Purpose of the Study:
- To evaluate the effectiveness of ultrasonic biometry in diagnosing intrauterine growth retardation (IUGR).
- To compare the diagnostic performance of biparietal diameter (BPD), head circumference, and abdominal circumference for IUGR.
- To determine the optimal gestational age for performing ultrasound scans to screen for IUGR.
Main Methods:
- Prospective screening of 3616 pregnancies.
- Gestational dating performed before 24 weeks via ultrasound.
- Analysis of biparietal diameter (BPD), head circumference, and abdominal circumference measurements.
- Abnormal measurements defined as below the 25th percentile for gestational age to ensure high sensitivity.
Main Results:
- Abdominal circumference measurements demonstrated higher predictive value for IUGR compared to BPD or head circumference.
- The predictive value of a positive test ranged from 0.25 to 0.55, varying with gestational age at scan.
- Prediction accuracy significantly improved when scans were performed within two weeks of delivery.
Conclusions:
- Ultrasonic biometry is effective for screening intrauterine growth retardation (IUGR).
- Abdominal circumference is the most predictive parameter for diagnosing IUGR.
- The optimal gestational age for screening IUGR using ultrasound is 34 +/- 1 weeks.
Abstract:
This prospective screening program of a large obstetric population was designed to determine the effectiveness of ultrasonic biometry to diagnose intrauterine growth retardation. The results of 3616 pregnancies were analyzed. All pregnancies were dated before the 24th week by ultrasonic measurements. The study compared the effectiveness of three ultrasonic growth parameters: biparietal diameter (BPD), head circumference, and abdominal circumference, to detect intrauterine growth retardation and to determine the optimal gestational age to perform the scan for this purpose. To maintain a high sensitivity required in a screening program, all ultrasonic measurements below the 25th percentile for gestational age were considered abnormal. The predictive value of a positive test in this situation ranged from 0.25 to 0.55, depending on the week of gestation in which the scan was performed. Accuracy of predictions improved greatly when the scans were performed within two weeks of delivery. Abdominal circumference measurements were more predictive of intrauterine growth retardation than either head circumference or BPD measurements or the combination of these parameters. In view of the sensitivity of the test and the prevalence of the disorder, it is concluded that 34 +/- 1 weeks of gestation is the optimal time to screen patients ultrasonically for intrauterine growth retardation.