Screening for birth weight deviations by second and third trimester ultrasound scan


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Abstract

ObjectiveThe aim of this article was to predict small for gestational age (SGA, at or less than the fifth birth weight percentile) and large for gestational age (LGA, at or greater than the 95th birth weight percentile) fetuses by using maternal and fetal parameters from the second and third trimester ultrasound examinations.MethodThis article is a retrospective cohort study on 1979 singleton pregnancies that had a routine 20 to 24 weeks anomaly and a 30 to 34 weeks growth ultrasound scans. SGA delivered before 30 gestational weeks were excluded.ResultsSecond trimester estimated fetal weight (EFW2), uterine arteries pulsatility index (PI), and maternal pregnancy characteristics were predictive for SGA (SGA second trimester model: R2 = 0.225, area under the curve [AUC] = 0.815) and LGA (LGA second trimester model: R2 = 0.203, AUC = 0.793). Third trimester EFW (EFW3), EFW2, uterine arteries PI2, umbilical PI, and maternal pregnancy characteristics improved the prediction of SGA (SGA combined model: R2 = 0.423, AUC = 0.896) and LGA (LGA combined model: R2 = 0.383, AUC = 0.882). Contingent screening with risk stratification by the second trimester model performed equally well for SGA (AUC = 0.882) and LGA (AUC = 0.861) as the combined models.ConclusionSecond trimester model performs well in the prediction of SGA and LGA. The addition of third trimester scan offers substantial improvement. Contingency screening is feasible with similar effectiveness. © 2014 John Wiley & Sons, Ltd.What's already known about this topic?First trimester ultrasound scan in combination with maternal pregnancy characteristics and biochemical indices is predictive of small for gestational age and large for gestational age.Third trimester scan is the superior method to assess fetal growth.What does this study add?Second trimester scan has satisfactory performance in the prediction of small for gestational age and large for gestational age.Second and third trimester contingent screening for fetal growth deviations has similar performance to a routine second and third trimester screening.

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