Use of birth weight- vs. ultrasound-derived fetal weight classification methods: implications for detection of abnormal umbilical artery Doppler

Matthew M. Finneran 1 , 2 , Courtney A. Ware 1 , Jessica Russo 1 , Shaylyn Webster 1 , Susanne Mathew 1 , Irina A. Buhimschi 3  and Catalin S. Buhimschi 3
  • 1 Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
  • 2 Division of Maternal-Fetal Medicine, Medical University of South Carolina, 96 Jonathan Lucas St., MSC 643, Charleston, SC 29425-1600, USA
  • 3 The University of Illinois College of Medicine, Chicago, IL, USA
Matthew M. Finneran
  • Corresponding author
  • Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
  • Division of Maternal-Fetal Medicine, Medical University of South Carolina, 96 Jonathan Lucas St., MSC 643, Charleston, SC 29425-1600, USA
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, Courtney A. Ware
  • Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
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, Jessica Russo
  • Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
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, Shaylyn Webster
  • Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
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, Susanne Mathew
  • Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
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, Irina A. Buhimschi and Catalin S. Buhimschi

Abstract

Objectives

To compare a birth weight-derived (Brenner) and multiple ultrasound-derived [Hadlock, National Institute of Child Health and Human Development (NICHD), International Fetal and Newborn Growth Consortium (INTERGROWTH)] classification systems’ frequency of assigning an antenatal estimated fetal weight (EFW) <10% and subsequent detection rate for abnormal umbilical artery Doppler (UAD).

Methods

We analyzed 569 consecutive non-anomalous singleton gestations identified by ultrasound with either an abdominal circumference (AC) <3% or EFW <10% at a tertiary medical center between 1/2012 and 12/2016. The biometric measurements were exported for all serial ultrasounds and the sensitivity, specificity, positive and negative predictive values, and area under the curve (AUC) were calculated for the diagnosis of any abnormal UAD, absent or reversed end-diastolic flow (AREDF), and small for gestational age (SGA) for each classification method.

Results

Brenner classified less patients with EFW <10% (49.7%) vs. the comparison methods (range: 84.2–85.0%; P < 0.001). The sensitivity was highest using Hadlock for detection of any abnormal UAD [96.6%; confidence interval (CI) 92.8–98.8%], AREDF (100%; CI 95.1–100%), and SGA (89.0%; CI 85.4–91.6%). However, there was minimal variation between the Hadlock, NICHD, and INTERGROWTH methods for detection of the studied outcomes. The AUCs for any abnormal UAD, AREDF, and SGA were highest for the Brenner method, but there were a substantial number of false-negative results with lower overall detection rates.

Conclusions

Use of a birth weight-derived method to assign a fetal weight <10% as the threshold to initiate UAD surveillance has a lower detection rate for abnormal UAD when compared to ultrasound-derived methods. Despite substantial methodological differences in the creation of the Hadlock, NICHD, and INTERGROWTH methods, there were no differences in the detection rates of abnormal UAD.

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