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Updated: Jun 11, 2025
Fetal Echocardiography and Pulsed-wave Doppler Ultrasound in a Rabbit Model of Intrauterine Growth Restriction
Published on: June 29, 2013
Expanded Fetal Growth Restriction Definition Identifies High Proportion of Umbilical Artery Doppler Anomalies
Angela Nakahra1, Miranda Long1, Ardem Elmayan2
1Department of Obstetrics and Gynecology, Ochsner Health, New Orleans, Louisiana.
Insights
The expanded definition of fetal growth restriction (FGR), including abdominal circumference (AC) and estimated fetal weight (EFW), improves the detection of abnormal umbilical artery Dopplers (UAD). This updated FGR definition aids in earlier identification of at-risk pregnancies.
Area of Science:
- Perinatology and Maternal-Fetal Medicine
- Fetal Ultrasound and Doppler Studies
- Reproductive Endocrinology
Background:
- Fetal growth restriction (FGR) is a significant risk factor for adverse perinatal outcomes.
- The Society for Maternal-Fetal Medicine expanded FGR criteria to include abdominal circumference (AC) <10th percentile, independent of estimated fetal weight (EFW).
- Previous studies confirmed improved detection of small-for-gestational-age neonates with the expanded definition, but its impact on identifying abnormal umbilical artery Dopplers (UAD) was unknown.
Purpose of the Study:
- To compare the likelihood of detecting UAD abnormalities in fetuses meeting the expanded FGR definition (normal EFW with restricted AC) versus those identified by EFW alone.
- To evaluate the diagnostic performance of UAD abnormalities in identifying FGR using different definitional criteria.
Main Methods:
- Retrospective cohort study analyzing fetal growth ultrasounds meeting FGR criteria (EFW <10th percentile or AC <10th percentile with normal EFW).
- Comparison of UAD abnormality prevalence (elevated systolic/diastolic ratio, absent/reversed end-diastolic velocity) between fetuses identified by AC criteria alone versus EFW criteria.
- Receiver operator characteristic (ROC) curve analysis to assess the predictive value of UAD abnormalities for each FGR definition.
Main Results:
- Of 619 FGR scans, 441 (71%) met EFW criteria and 178 (29%) met AC criteria alone. FGR by AC alone was diagnosed earlier in gestation (30.4 vs. 35.4 weeks) and more frequently before 32 weeks (70% vs. 11%).
- The proportion of abnormal UAD was similar between groups (15% vs. 15%). However, using EFW alone would have missed 29% of abnormal UAD findings.
- A combined definition of FGR (considering both EFW and AC) demonstrated the highest detection rate for abnormal UAD (Area Under Curve: 0.78), outperforming EFW alone (0.69) and AC alone (0.73).
Conclusions:
- An FGR definition incorporating both EFW and AC significantly enhances the detection of abnormal UAD compared to using EFW criteria alone.
- Fetuses with restricted AC show a similar likelihood of abnormal UAD indices as those meeting FGR criteria by EFW.
- The expanded FGR definition facilitates earlier detection of FGR and improves the identification of associated abnormal Doppler findings.
Objective:
Fetal growth restriction (FGR) increases the risk for perinatal morbidity and mortality. The Society for Maternal-Fetal Medicine expanded the definition of FGR to independently include abdominal circumference (AC) < 10th percentile for gestational age (GA), regardless of estimated fetal weight (EFW). While studies have shown increased detection of small for GA neonates with expanded definition, no studies have evaluated the likelihood of abnormal umbilical artery Dopplers (UAD) detection with expanded definition. The objective of this study was to compare the likelihood of identifying UAD abnormalities in fetuses with normal EFW and restricted AC versus those by EFW alone.
Study Design:
Single-institution retrospective cohort study of fetal growth ultrasounds meeting criteria for FGR either by EFW < 10th percentile or AC < 10th percentile with normal EFW. Those with FGR by AC alone were compared with those with FGR by EFW. Primary outcome was prevalence of UAD abnormalities, including elevated systolic/diastolic ratio, and absent and/or reversed end diastolic velocity. Receiver operator characteristic curves were generated to compare predictive value of UAD abnormalities by FGR definition.
Results:
A total of 619 scans met criteria for FGR between November 2020 and June 2021, with 441 (71%) meeting definition by EFW and 178 (29%) by AC criteria alone. Baseline characteristics were similar between groups. FGR by AC alone was identified earlier (30.4 ± 3.3 vs. 35.4 ± 3.0 weeks' gestation, p < 0.001) with higher proportion identified before 32 weeks (70 vs. 11%, p < 0.001). Proportion of abnormal UAD were similar between groups (15 vs. 15%, adjusted odds ratio: 1.12, 95% confidence interval: 0.61-2.23). Use of EFW alone would have failed to identify 29% of abnormal UAD. A combined definition of FGR had the highest detection of abnormal UAD (area under curve: 0.78 vs. AC alone 0.73 vs. EFW alone 0.69).
Conclusion:
A definition of FGR that considers both EFW and AC improves detection of abnormal UAD.
Key Points:
· Fetuses with restricted AC are equally likely to exhibit abnormal UAD indices compared with those that meet criteria by EFW.. · Earlier GA of FGR detection and improved detection of abnormal UAD with expanded growth definition.. · Expanded definition of FGR significantly improves detection of abnormal UAD as compared with those diagnosed with EFW criteria alone.. · Expanded growth restriction definition improves Doppler identification..
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