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Screening for intrauterine growth retardation using the ultrasound biparietal diameter
Insights
Predicting fetal growth using biparietal diameter (BPD) ultrasound measurements showed limitations. While useful in some cases, this method had a high false positive rate and poor sensitivity for detecting intrauterine growth retardation.
Area of Science:
- Obstetrics and Gynecology
- Fetal Medicine
- Diagnostic Imaging
Background:
- Accurate fetal age and weight prediction is crucial for managing pregnancies.
- Intrauterine growth retardation (IUGR) is a significant concern, requiring reliable diagnostic methods.
- Biparietal diameter (BPD) measurements via ultrasound are commonly used in prenatal assessments.
Purpose of the Study:
- To evaluate the effectiveness of biparietal diameter (BPD) measurements in predicting fetal age and weight.
- To assess the accuracy of BPD measurements in identifying fetuses that are small for gestational age (SGA).
- To determine the diagnostic performance of different BPD-based screening criteria for IUGR.
Main Methods:
- A cohort of 1500 patients underwent prenatal ultrasound scans for BPD measurement.
- Three hundred eleven patients had serial BPD scans.
- Screening criteria included absolute BPD below the third percentile, delta BPD less than 50% of mean growth rate, or a combination.
Main Results:
- Forty-three cases of SGA were identified.
- IUGR was most accurately determined with an absolute small BPD at the last scan and accurate gestational age.
- Prediction was least accurate with a single BPD measurement and poor clinical dates.
- Ultrasound BPD screening demonstrated a 50% false positive rate and poor sensitivity for IUGR.
Conclusions:
- BPD measurements alone have limitations as a screening tool for IUGR.
- Combining absolute BPD with accurate gestational age assessment improves diagnostic accuracy.
- Further refinement of ultrasound screening protocols is needed for better detection of IUGR.
Abstract:
Fifteen hundred patients were scanned to predict fetal age and weight by biparietal diameter measurement. three hundred eleven patients had more than one scan. Forty-three small for gestational age (SGA) babies were ultimately delivered in this population. Prenatal ultrasound screening criteria for grouping into appropriate for gestational age (AGA) or small for gestational age (SGA) categories were: a) only an absolute biparietal diameter below the third percentile for the reference Rochester region population; b) only delta BPD calculated as less than 50 percent of the mean growth rate for the reference population; and c) a combination of these two factors. Intrauterine growth retardation was most accurately determined when an absolutely small biparietal diameter was found (at the time of the last ultrasound examination) in a woman with accurate gestational age assessment. Least accurate was the prediction based on one biparietal diameter measurement in a woman with poor clinical dates. A 50 percent false positive detection rate and poor sensitivity to intrauterine growth retardation were found using ultrasound biparietal diameter measurements as a screening test in this manner.