Am J Perinatol 2017; 34(4): 409-414
DOI: 10.1055/s-0036-1592132
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Small for Gestational Age: The Differential Mortality When Detected versus Undetected Antenatally

Jacob C. Larkin
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Suneet P. Chauhan
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
,
Hyagriv N. Simhan
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
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Weitere Informationen

Publikationsverlauf

27. Juni 2016

27. Juli 2016

Publikationsdatum:
14. September 2016 (online)

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Abstract

Background Antenatal detection of fetal growth restriction (FGR) prompts antepartum surveillance to reduce perinatal mortality, yet most cases of FGR are undetected.

Objective This study aims to compare rates of adverse neonatal outcomes when FGR is detected versus undetected.

Study Design Small-for-gestational-age (SGA) newborns (birth weight < 10% for gestational age) delivered at the Magee-Women's Hospital in Pittsburgh, PA from 2003 to 2010 were divided into three groups: those whom did not undergo third-trimester fetal growth ultrasound (SGA-no US), were appropriate for gestational age (AGA) by ultrasound (SGA-undetected), or were FGR by ultrasound (SGA-detected). We then compared rates of 5-minute Apgar < 4 and neonatal death (ND), with AGA newborns as the referent.

Results Out of 29,885 neonates, 2,475 (8.3%) were SGA. Out of the 826 (33%) SGA neonates who underwent growth ultrasound, 185 (22%) were considered FGR. In the SGA-no US group, the adjusted odds ratio (aOR) for Apgar < 4 was 2.84 (95% confidence interval (CI): 1.28–6.29) and 3.87 (95% CI: 2.09–7.18) for ND. The risk of Apgar < 4 (aOR: 3.10, 95% CI: 0.93–10.28) and ND (aOR: 2.16, 95% CI: 0.66–7.14) were not significantly elevated for SGA-undetected neonates, while SGA-detected neonates were most at risk, with an aOR of 18.20 (95% CI: 6.82–48.60) for Apgar < 4 and 18.24 (95% CI: 7.90–42.13) for ND.

Conclusion Fetal growth ultrasound effectively stratifies risk amongst SGA neonates.

Note

These findings were presented at the 35th Annual Meeting of the Society for Maternal Fetal Medicine; February 6, 2015; San Diego, CA.