Download PDF
CC BY-NC-ND 4.0 · AJP Rep 2021; 11(04): e132-e136
DOI: 10.1055/s-0041-1740170
Case Report

Clinical Implications of Second and Third Trimester Surveillance Ultrasounds of Growth-Restricted Fetuses

Amanda M. Craig 
1   Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
,
Karampreet Kaur 
2   Vanderbilt University School of Medicine, Nashville, Tennessee
,
Sarah A. Heerboth
2   Vanderbilt University School of Medicine, Nashville, Tennessee
,
Heidi Chen
3   Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
,
Chelsea J. Lauderdale
4   Surgical Outcomes Center for Kids, Monroe Carell Junior Children's Hospital at Vanderbilt, Nashville, Tennessee
,
Chevis Shannon
4   Surgical Outcomes Center for Kids, Monroe Carell Junior Children's Hospital at Vanderbilt, Nashville, Tennessee
,
Lisa C. Zuckerwise
5   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Objective We sought to investigate the positive predictive value of ultrasound-diagnosed fetal growth restriction (FGR) for estimating small for gestational age (SGA) at birth. Secondary objectives were to describe clinical interventions performed as a result of FGR diagnosis.

Study Design This was a retrospective cohort of pregnancies diagnosed with FGR over 3 years at a single institution. Maternal demographics, antenatal and delivery data, and neonatal data were collected. Descriptive statistics and linear regression were conducted.

Results We included 406 pregnancies with diagnosis of FGR in second or third trimester. Median birth weight percentile was 17 (interquartile range: 5–50) and only 35.0% of these fetuses were SGA at birth. The positive predictive value of a final growth ultrasound below the 10th percentile for SGA at birth was 56.9%. Patients averaged eight additional growth ultrasounds following FGR diagnosis. One hundred and fourteen (28.1%) received antenatal steroids prior to delivery, and 100% of those delivered after more than 7 days following administration. There were 6 fetal deaths and 14 neonatal deaths.

Conclusion In the majority of cases, pregnancies diagnosed with FGR during screening ultrasounds resulted in normally grown neonates and term deliveries. These patients may be receiving unnecessary ultrasounds and premature courses of corticosteroids.

Keywords

fetal growth restriction - ultrasound - pregnancy - antenatal corticosteroids


Publication History

Received: 05 August 2020

Accepted: 08 October 2021

Article published online:
23 November 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Society for Maternal-Fetal Medicine (SMFM). Martins JG, Biggio JR, Abuhamad A. Society for Maternal-Fetal Medicine Consult Series #52: diagnosis and management of fetal growth restriction: (Replaces Clinical Guideline Number 3, April 2012). Am J Obstet Gynecol 2020; 223 (04) B2-B17
    CrossrefPubMedGoogle Scholar
  • 2 ACOG practice bulletin no. 134: fetal growth restriction. Obstet Gynecol 2013; 121 (05) 1122-1133
    CrossrefPubMedGoogle Scholar
  • 3 Gardosi J, Madurasinghe V, Williams M, Malik A, Francis A. Maternal and fetal risk factors for stillbirth: population based study. BMJ 2013; 346: f108
    CrossrefPubMedGoogle Scholar
  • 4 Chauhan SP, Beydoun H, Chang E. et al. Prenatal detection of fetal growth restriction in newborns classified as small for gestational age: correlates and risk of neonatal morbidity. Am J Perinatol 2014; 31 (03) 187-194
    PubMedGoogle Scholar
  • 5 Mendez-Figueroa H, Truong VT, Pedroza C, Chauhan SP. Morbidity and mortality in small-for-gestational-age infants: a secondary analysis of nine MFMU Network studies. Am J Perinatol 2017; 34 (04) 323-332
    PubMedGoogle Scholar
  • 6 Unterscheider J, O'Donoghue K, Daly S. et al. Fetal growth restriction and the risk of perinatal mortality-case studies from the multicentre PORTO study. BMC Pregnancy Childbirth 2014; 14: 63
    CrossrefPubMedGoogle Scholar
  • 7 Ray JG, Park AL, Fell DB. Mortality in infants affected by preterm birth and severe small-for-gestational age birth weight. Pediatrics 2017; 140 (06) e20171881
    CrossrefPubMedGoogle Scholar
  • 8 Bamfo JE, Odibo AO. Diagnosis and management of fetal growth restriction. J Pregnancy 2011; 2011: 640715
    CrossrefPubMedGoogle Scholar
  • 9 Resnik R. Intrauterine growth restriction. Obstet Gynecol 2002; 99 (03) 490-496
    PubMedGoogle Scholar
  • 10 Goetzinger KR, Tuuli MG, Odibo AO, Roehl KA, Macones GA, Cahill AG. Screening for fetal growth disorders by clinical exam in the era of obesity. J Perinatol 2013; 33 (05) 352-357
    CrossrefPubMedGoogle Scholar
  • 11 Committee on Practice Bulletins—Obstetrics and the American Institute of Ultrasound in Medicine. 175: Ultrasound in pregnancy. Obstet Gynecol 2016; 128 (06) e241-e256
    CrossrefPubMedGoogle Scholar
  • 12 Siddique J, Lauderdale DS, VanderWeele TJ, Lantos JD. Trends in prenatal ultrasound use in the United States: 1995 to 2006. Med Care 2009; 47 (11) 1129-1135
    CrossrefPubMedGoogle Scholar
  • 13 O'Keeffe DF, Abuhamad A. Obstetric ultrasound utilization in the United States: data from various health plans. Semin Perinatol 2013; 37 (05) 292-294
    CrossrefPubMedGoogle Scholar
  • 14 Monier I, Blondel B, Ego A, Kaminiski M, Goffinet F, Zeitlin J. Poor effectiveness of antenatal detection of fetal growth restriction and consequences for obstetric management and neonatal outcomes: a French national study. BJOG 2015; 122 (04) 518-527
    CrossrefPubMedGoogle Scholar
  • 15 Sovio U, White IR, Dacey A, Pasupathy D, Smith GCS. Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study. Lancet 2015; 386 (10008): 2089-2097
    CrossrefPubMedGoogle Scholar
  • 16 Gabbay-Benziv R, Aviram A, Hadar E. et al. Pregnancy outcome after false diagnosis of fetal growth restriction. J Matern Fetal Neonatal Med 2017; 30 (16) 1916-1919
    CrossrefPubMedGoogle Scholar
  • 17 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research Electronic Data Capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
    CrossrefPubMedGoogle Scholar
  • 18 Minior VK, Divon MY. Fetal growth restriction at term: myth or reality?. Obstet Gynecol 1998; 92 (01) 57-60
    CrossrefPubMedGoogle Scholar
  • 19 Committee on Obstetric Practice. Committee Opinion No. 713: antenatal corticosteroid therapy for fetal maturation. Obstet Gynecol 2017; 130 (02) e102-e109
    CrossrefPubMedGoogle Scholar
  • 20 Romagnoli S, Zagli G, Tuccinardi G. et al. Postoperative acute kidney injury in high-risk patients undergoing major abdominal surgery. J Crit Care 2016; 35: 120-125
    CrossrefPubMedGoogle Scholar
  • 21 Roberts D, Brown J, Medley N, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2017; 3: CD004454
    CrossrefPubMedGoogle Scholar
  • 22 Boesveld M, Heida KY, Oudijk MA, Brouwers HA, Koenen SV, Kwee A. Evaluation of antenatal corticosteroid prescribing patterns among 984 women at risk for preterm delivery. J Matern Fetal Neonatal Med 2014; 27 (05) 516-519
    CrossrefPubMedGoogle Scholar
  • 23 Adams TM, Kinzler WL, Chavez MR, Vintzileos AM. The timing of administration of antenatal corticosteroids in women with indicated preterm birth. Am J Obstet Gynecol 2015; 212 (05) 645.e1-645.e4
    CrossrefPubMedGoogle Scholar
  • 24 Gyamfi-Bannerman C, Thom EA, Blackwell SC. et al; NICHD Maternal–Fetal Medicine Units Network. Antenatal betamethasone for women at risk for late preterm delivery. N Engl J Med 2016; 374 (14) 1311-1320
    CrossrefPubMedGoogle Scholar
  • 25 Frøen JF, Gardosi JO, Thurmann A, Francis A, Stray-Pedersen B. Restricted fetal growth in sudden intrauterine unexplained death. Acta Obstet Gynecol Scand 2004; 83 (09) 801-807
    CrossrefPubMedGoogle Scholar
  • 26 Lees C, Marlow N, Arabin B. et al; TRUFFLE Group. Perinatal morbidity and mortality in early-onset fetal growth restriction: cohort outcomes of the trial of randomized umbilical and fetal flow in Europe (TRUFFLE). Ultrasound Obstet Gynecol 2013; 42 (04) 400-408
    CrossrefPubMedGoogle Scholar