An integrated model with classification criteria to predict small‐for‐gestational‐age fetuses at risk of adverse perinatal outcome. (27th January 2015)

• Record Type: Journal Article
• Authors: Figueras, F.; Savchev, S.; Triunfo, S.; Crovetto, F.; Gratacos, E.
• Is Part Of: Ultrasound in obstetrics & gynecology. Volume 45:Number 3(2015:Mar.)
• Page Start: 279
• Page End: 285
• Publication Date: 2015-01-27
• Subjects: Ultrasonics in obstetrics -- Periodicals; Generative organs, Female -- Diseases -- Diagnosis -- Periodicals; Diagnosis, Ultrasonic -- Periodicals; Genital Diseases, Female -- ultrasonography -- Periodicals; Ultrasonography, Prenatal -- Periodicals; 618.047543
• DOI: 10.1002/uog.14714
• Languages: English
• ISSNs: 0960-7692

Abstract

<abstract abstract-type="main" id="uog14714-abs-0001"> <title>Abstract</title> <sec id="uog14714-sec-0001" sec-type="section"> <title>Objective</title> <p id="uog14714-para-0001">To develop an integrated model with the best performing criteria for predicting adverse outcome in small‐for‐gestational‐age (SGA) pregnancies.</p> </sec> <sec id="uog14714-sec-0002" sec-type="section"> <title>Methods</title> <p id="uog14714-para-0002">A cohort of 509 pregnancies with a suspected SGA fetus, eligible for trial of labor, was recruited prospectively and data on perinatal outcome were recorded. A predictive model for emergency Cesarean delivery because of non‐reassuring fetal status or neonatal acidosis was constructed using a decision tree analysis algorithm, with predictors: maternal age, body mass index, smoking, nulliparity, gestational age at delivery, onset of labor (induced <italic>vs</italic> spontaneous), estimated fetal weight (EFW), umbilical artery pulsatility index (PI), mean uterine artery (UtA) PI, fetal middle cerebral artery PI and cerebroplacental ratio (CPR).</p> </sec> <sec id="uog14714-sec-0003" sec-type="section"> <title>Results</title> <p id="uog14714-para-0003">An adverse outcome occurred in 134 (26.3%) cases. The best performing predictors for defining a high risk for adverse outcome in SGA fetuses was the presence of a CPR < 10<sup>th</sup> centile, a mean UtA‐PI > 95<sup>th</sup> centile or an EFW < 3<sup>rd</sup> centile. The algorithm showed a sensitivity, specificity and positive and negative predictive values for adverse outcome of 82.8% (95% CI, 75.1–88.6%), 47.7% (95% CI, 42.6–52.9%), 36.2% (95% CI, 30.8–41.8%) and 88.6% (95% CI, 83.2–92.5%), respectively. Positive and negative likelihood ratios were 1.58 and 0.36.</p> </sec> <sec id="uog14714-sec-0004" sec-type="section"> <title>Conclusions</title> <p id="uog14714-para-0004">Our model could be used as a diagnostic tool for discriminating SGA pregnancies at risk of adverse perinatal outcome. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.</p> </sec> </abstract>