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Prenatal prediction of neonatal growth status in twins using individualized growth assessment
Author(s) -
Deter Russell L.,
Xu Bishong,
Milner Lizabeth L.
Publication year - 1996
Publication title -
journal of clinical ultrasound
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.272
H-Index - 61
eISSN - 1097-0096
pISSN - 0091-2751
DOI - 10.1002/(sici)1097-0096(199602)24:2<53::aid-jcu1>3.0.co;2-j
Subject(s) - medicine , head circumference , obstetrics , birth weight , ultrasound , fetus , pregnancy , genetics , radiology , biology
Objective To determine if the growth status at birth of twins can be predicted in the third trimester using the Prenatal Growth Assessment Score (PGAS). Methods The growth of 40 twin fetuses were studied with ultrasound from 14 weeks until delivery. Measurements of the head circumference (HC), abdominal circumference (AC), thigh circumference (ThC), femur diaphysis length (FDL), head cube (A), and abdominal cube (B) were made at 2 to 3 week intervals. Rossavik growth models for these parameters were determined from second trimester measurements. These models were used to define expected third trimester growth curves and birth characteristics. Comparisons of expected and actual third trimester measurements were used to calculate PGAS values after various time points (PGAS At ) and after the last time point (PGAS AT ). Similar comparisons after birth were used to determine Growth Potential Realization Index (GPRI) values for HC, AC, ThC, weight (WT), and crown‐heel length (CHL), with and without correction for decreased soft tissue deposition. These two sets of GPRI values were used to calculate two sets of Neonatal Growth Assessment Scores (NGAS S , NGAS Tw ). Using NGAS S and NGAS Tw (as well as GPRI values in some cases), the twin neonates were classified as Normal (N), Decreased Soft Tissue Deposition, (DSTD), Intrauterine Growth Retardation (IUGR), and Macrosomia (M). Results At birth 22/40 (55%) were classified as N, 9/40 (22.5%) as DSTD, 6/40 (15.0%) as IUGR, and 3/40 (7.5%) as M. All −PGAS AT values in the N group were greater than −0.40% with one exception (−PGAS AT = −0.43%). All PGAS At values were above this same boundary except for one fetus. No differences were seen between the N and DSTD groups [mean −PGAS AT (range): N, −0.12% (0% to −0.34%); DSTD, −0.10% (0% to −0.30%)]. The IUGR group had 4 fetuses with −PGAS AT values between −0.65% and 2.79% and two with values of 0.0% and −0.12%. Growth retardation in the latter two was limited to a decrease in thigh soft tissue deposition. −PGAS At values in the first 4 fetus were below −0.40% 1.6 to 9.5 weeks before delivery (mean: 6.1 weeks). Fetuses in group M had +PGAS AT values of 0.0%, +1.8%, and +1.2%. PGAS At values were above +0.40% at 3.6 and 9.8 weeks before delivery in the latter two fetuses. Conclusions These results support the concept that PGAS AT and PGAS At values outside ± 0.40% indicate either IUGR or macrosomia. Almost all fetuses with growth problems in the third trimester can be detected, on average, 6 weeks before delivery unless the growth abnormality is limited to decreased soft tissue deposition. © 1996 John Wiley & Sons, Inc.