Combination of Fundal Height and Ultrasound to Predict Small for Gestational Age at Birth

Katherine L. Grantz; Ana M. Ortega-Villa; Sarah J. Pugh; Alaina Bever; William Grobman; Roger B. Newman; John Owen; Deborah A. Wing; Paul S. Albert

doi:10.1055/s-0041-1728837

American Journal of Perinatology, Table of Contents

Am J Perinatol 2023; 40(02): 155-162
DOI: 10.1055/s-0041-1728837

Original Article

Combination of Fundal Height and Ultrasound to Predict Small for Gestational Age at Birth

Katherine L. Grantz

¹Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland

,

Ana M. Ortega-Villa

²Biostatistics Research Branch, Division Clinical Research, National Institute of Allergy and Infectious Diseases, Fishers Lane, Rockville, Maryland

,

Sarah J. Pugh

¹Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland

,

Alaina Bever

¹Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland

,

William Grobman

³Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois

,

Roger B. Newman

⁴Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina

,

John Owen

⁵Department of Obstetrics and Gynecology, The University of Alabama at Birmingham Center for Women's Reproductive Health, Birmingham, Alabama

,

Deborah A. Wing

⁶Department of Obstetrics-Gynecology, Division of Maternal-Fetal Medicine, University of California, Irvine, School of Medicine, Orange, California

⁷Miller Children's Hospital/Long Beach Memorial Medical Center, Long Beach, California

,

Paul S. Albert

⁸Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland

› Author Affiliations

Abstract

Objective The objective of the study was to determine whether adding longitudinal measures of fundal height (FH) to the standard cross-sectional FH to trigger third trimester ultrasound estimated fetal weight (EFW) would improve small for gestational age (SGA) prediction.

Study Design We developed a longitudinal FH calculator in a secondary analysis of a prospective cohort study of 1,939 nonobese pregnant women who underwent serial FH evaluations at 12 U.S. clinical sites. We evaluated cross-sectional FH measurement ≤ –3 cm at visit 3 (mean: 32.0 ± 1.6 weeks) versus the addition of longitudinal FH up to and including visit 3 to trigger an ultrasound to diagnose SGA defined as birth weight <10th percentile. If the FH cut points were not met, the SGA screen was classified as negative. If FH cut points were met and EFW was <10th percentile, the SGA screen was considered positive. If EFW was ≥10th percentile, the SGA screen was also considered negative. Sensitivity, specificity, and positive predictive value (PPV) and negative predictive value (NPV) were computed.

Results In a comparison of methods, 5.8% of women were classified as at risk of SGA by both cross-sectional and longitudinal classification methods; cross-sectional FH identified an additional 4.0%, and longitudinal fundal height identified a separate, additional 4.5%.

Using cross-sectional FH as an ultrasound trigger, EFW had a PPV and NPV for SGA of 69 and 92%, respectively. After adding longitudinal FH, PPV increased to 74%, whereas NPV of 92% remained unchanged; however, the number of women who underwent triggered EFW decreased from 9.7 to 5.7%.

Conclusion An innovative approach for calculating longitudinal FH to the standard cross-sectional FH improved identification of SGA birth weight, while simultaneously reducing the number of triggered ultrasounds. As an essentially free-of-charge screening test, our novel method has potential to decrease costs as well as perinatal morbidity and mortality (through better prediction of SGA).

Key Points

We have developed an innovative calculator for fundal height trajectory.
Longitudinal fundal height improves detection of SGA.
As a low cost screening test, the fundal height calculator may decrease costs and morbidity through better prediction of SGA.

Keywords

birth weight percentile - fundal height - small for gestational age

Full Text

References

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Supplementary Material

Supplementary Material