Premium
Second‐trimester prediction of delivery of a small‐for‐gestational‐age neonate: integrating sequential Doppler information, fetal biometry, and maternal characteristics
Author(s) -
Seravalli Viola,
BlockAbraham Dana M.,
Turan Ozhan M.,
Doyle Lauren E.,
Blitzer Miriam G.,
Baschat Ahmet A.
Publication year - 2014
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.4418
Subject(s) - gestational age , obstetrics , medicine , fetus , doppler effect , pregnancy , second trimester , gestation , first trimester , biology , physics , astronomy , genetics
Objective The aim of this study was to investigate the predictive accuracy of second‐trimester ultrasound parameters, maternal characteristics, and sequential Doppler changes between first and second trimesters for the prediction of small‐for‐gestational‐age (SGA) infants (birth weight < 10th percentile). Methods We conducted a prospective study of singleton pregnancies enrolled in the first trimester with subsequent second‐trimester follow‐up. Maternal characteristics, uterine artery (UtA) pulsatility index (PI), fetal biometry, and umbilical artery (UA)‐PI were ascertained. UtA and UA‐PI change from first to second trimester was calculated (ΔUtA‐PI and ΔUA‐PI). These parameters were tested for their ability to predict delivery of an SGA infant. Results Among 1982 women, 172 delivered an SGA neonate. African‐American ethnicity, nulliparity, tobacco use, and low abdominal circumference (AC) z ‐score were independent predictors of SGA. No difference was found in the magnitude of ΔUtA‐PI and ΔUA‐PI between SGA and no‐SGA. Receiver–operating characteristics curve analysis yielded an area under the curve of 0.700 for AC z ‐score. The combination of low AC and bilateral notching had high specificity (99%) but low sensitivity (7%) for SGA prediction. Conclusions A small second‐trimester fetal AC is a specific marker for SGA when found with bilateral UtA notching. Only a small proportion is predicted by the factors studied, suggesting a small contributory role or later evolution of SGA. © 2014 John Wiley & Sons, Ltd.