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Prediction of stillbirth from maternal factors, fetal biometry and uterine artery Doppler at 19–24 weeks
Author(s) -
Akolekar R.,
Tokunaka M.,
Ortega N.,
Syngelaki A.,
Nicolaides K. H.
Publication year - 2016
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.17295
Subject(s) - placentation , medicine , obstetrics , uterine artery , gestation , logistic regression , gestational age , fetus , gynecology , pregnancy , prospective cohort study , placenta , biology , genetics
ABSTRACT Objectives To evaluate the performance of screening for all stillbirths and those due to impaired placentation and unexplained or other causes using a combination of maternal factors, fetal biometry and uterine artery pulsatility index ( UtA‐PI ) at 19–24 weeks' gestation and to compare this performance with that of screening by UtA‐PI alone. Methods This was a prospective screening study of 70 003 singleton pregnancies including 69 735 live births and 268 (0.38%) antepartum stillbirths; 159 (59%) were secondary to impaired placentation and 109 (41%) were due to other or unexplained causes. Multivariable logistic regression analysis was used to develop a model for prediction of stillbirth based on a combination of maternal factors, fetal biometry and UtA‐PI . Results Combined screening predicted 55% of all stillbirths, including 75% of those due to impaired placentation and 23% of those that were unexplained or due to other causes, at a false‐positive rate of 10%. Within the impaired placentation group, the detection rate of stillbirth < 32 weeks' gestation was higher than that of stillbirth ≥ 37 weeks (88% vs 46%; P < 0.001). The performance of screening by the combined test was superior to that of selecting the high‐risk group on the basis of UtA‐PI > 90 th percentile for gestational age, which predicted 48% of all stillbirths, 70% of those due to impaired placentation and 15% of those that were unexplained or due to other causes. Conclusions Second‐trimester screening by a combination of UtA‐PI with maternal factors and fetal biometry can predict a high proportion of stillbirths and, in particular, those that are due to impaired placentation. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.