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Published on: June 29, 2013
Comparative Diagnostic Performance of Estimated Fetal Weight and Isolated Abdominal Circumference for the Detection
Megan D Whitham1, David M Reynolds1, Amanda R Urban1
1Department of Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville, VA, USA.
Insights
Diagnosing fetal growth restriction (FGR) using isolated abdominal circumference (AC) <10% did not improve detection of small-for-gestational age (SGA) or composite perinatal morbidity (CPM). The criteria showed similar performance but with lower specificity and higher false positives for AC alone.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Fetal Development
Background:
- Fetal growth restriction (FGR) is a critical condition affecting pregnancy outcomes.
- Accurate diagnostic criteria for FGR are essential for timely intervention.
- Current criteria often rely on estimated fetal weight (EFW), but the utility of isolated abdominal circumference (AC) measurements is debated.
Purpose of the Study:
- To compare the diagnostic performance of EFW <10% versus isolated AC <10% for identifying FGR.
- To assess the association of these criteria with small-for-gestational age (SGA) and composite perinatal morbidity (CPM).
Main Methods:
- Retrospective cohort study of 1587 patients with available ultrasound and delivery data.
- FGR diagnosed by EFW <10% or isolated AC <10% using Hadlock and Duryea centiles.
- SGA defined at birth; CPM defined as birthweight <3% or birthweight <10% with neonatal morbidity.
Main Results:
- 1.8% of patients (28/1587) were classified as FGR by EFW <10%.
- Isolated AC <10% had a 25% progression to EFW <10% later in pregnancy.
- Both criteria showed comparable sensitivity for SGA and CPM, but isolated AC <10% had decreased specificity and increased false positives for SGA.
Conclusions:
- Expanding FGR diagnosis to include isolated AC <10% did not significantly enhance the detection of pregnancies at risk for SGA or CPM.
- The study may lack statistical power due to the low incidence of SGA and CPM.
- Clinical application of isolated AC <10% requires careful consideration of its impact on false positive rates.
Objectives:
To describe the comparative incidence, detection of small-for-gestational age (SGA), and composite perinatal morbidity (CPM) associated with diagnostic criteria of fetal growth restriction (FGR) by estimated fetal weight (EFW) <10% with those with isolated abdominal circumference (AC) measurements <10%.
Methods:
We performed a retrospective cohort study of 1587 patients receiving prenatal care and delivery at our institution. We included all patients with ultrasounds and delivery outcomes available, and excluded terminations, second trimester losses, and pregnancies without ultrasounds. EFW was calculated from Hadlock and use of the Duryea centiles, and AC from Hadlock's reference curves. We determined SGA at birth and defined CPM as birthweight less than 3% or birthweight less than 10% with neonatal morbidity.
Results:
Of 1587 patients, 28 (1.8%) were classified as FGR by EFW <10%. Three of 12 patients with isolated AC <10% developed EFW <10% later in pregnancy (25%). The performance of each diagnostic criteria were comparable for the outcomes of SGA and CPM, with similar sensitivities, but with decreased specificity for SGA outcome, and an increased false positive rate for patients classified as FGR by isolated AC <10, with a tradeoff of decreased false negatives.
Conclusions:
Broadening the diagnosis of FGR to include patients with isolated AC <10 did not significantly increase the detection of pregnancies at risk for SGA or CPM. Our conclusions may be limited by a lack of statistical power given a low frequency of SGA and CPM.
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