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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, Joachim W.

Editorial Board Member: / Bancalari, Eduardo / Milner, Anne / Genc, Mehmet R. / Chervenak, Frank A. / Chappelle, Joseph / Bergmann, Renate L. / Bernardes, J.F. / Bevilacqua, G. / Blickstein, Isaac / Cabero Roura, Luis / Carbonell-Estrany, Xavier / Carrera, Jose M. / D`Addario, Vincenzo / D'Alton, MD, Mary E. / Dimitrou, G. / Grunebaum, Amos / Hentschel, Roland / Köpcke, W. / Kawabata, Ichiro / Keirse, Marc J.N.C. / Kurjak M.D., Asim / Lee, Ben H. / Levene, Malcolm / Lockwood, Charles J. / Marsal, Karel / Makatsariya, Alexander / Nishida, Hiroshi / Papp, Zoltán / Pejaver, Ranjan Kumar / Pooh, Ritsuko K. / Romero, Roberto / Saugstad, Ola D. / Schenker, Joseph G. / Sen, Cihat / Seri, Istvan / Vetter, Klaus / Winn, Hung N. / Young, Bruce K. / Zimmermann, Roland

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1619-3997
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In This Section
Volume 36, Issue 4 (Jul 2008)

Issues

Value of a single early third trimester fetal biometry for the prediction of birth weight deviations in a low risk population

Paul A.O.M. De Reu
  • 1Midden Brabant Midwifery Care Center, Boxtel, The Netherlands
/ L.J.M. Smits
  • 2Department of Epidemiology, Maastricht University Medical Center, Maastricht, The Netherlands
/ H.P. Oosterbaan
  • 3Department of Obstetrics and Gynecology, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
/ J.G. Nijhuis
  • 4Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands
Published Online: 2008-07-03 | DOI: https://doi.org/10.1515/JPM.2008.057

Abstract

Objective: To analyze the value of a single ultrasound biometry examination at the onset of the third trimester of pregnancy for the detection of small-for-gestational-age (SGA) and large-for-gestational-age (LGA) at birth in a low risk population. The aim of this study was to develop a simple and useful method for the detection of growth deviations during pregnancy in primary care (midwife or general practitioner) practices.

Setting: A Dutch primary care midwifery practice.

Study design: In an earlier study, we developed parity and sex specific fetal growth charts of abdominal circumference (AC) and head circumference (HC) on the basis of ultrasound data of a low-risk midwifery population in the Netherlands. In the present study, we calculated sensitivity, specificity and predictive values at different cut-off points of AC and HC for the prediction of growth deviations at birth. Patients booked for perinatal care between 1 January 1993 and 31 December 2003 (n=3449) were used for the identification of cut-off points (derivation cohort) and those admitted between 1 January 2004 and 31 December 2005 (n=725) were used to evaluate the performance of these cut-offs in an independent population (validation cohort). For the determination of SGA and macrosomia at birth, we used the recently published Dutch birth weight percentiles.

Results: Most promising cut-offs were AC ≤25th percentile for the prediction of SGA (birth weight ≤10th percentile) and AC ≥75th percentile for the prediction of macrosomia (birth weight ≥90th percentile). Within the validation cohort these cut-offs performed slightly better than in the derivation cohort. For the prediction of SGA, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 53% (95% CI 49–58%), 81% (95% CI 80–83%), 26% (95% CI 23–29%), and 93% (95% CI 93–94%), respectively. The false positive rate was 74%. For the prediction of macrosomia, the values of these parameters were 64% (95% CI 59–69%), 80% (95% CI 78–81%), 23% (95% CI 20–26%), and 96% (95% CI 95–97%), respectively. Here, false positive rate was 77%. No cut-offs were found that predicted extreme birth weight deviations (≤2.3 percentile; ≥97.7 percentile) sufficiently well.

Conclusions: In a low risk population, we could predict future growth deviations with a higher sensitivity and in a significant earlier stage (at the onset of the third trimester of pregnancy) than with the use of conventional screening methods (i.e., palpation of the uterus only and fundus-symphysis measurement). Sonographic measurement of fetal abdominal circumference enables to detect more than half of cases of SGA at birth and more than two-thirds of cases of macrosomia with acceptable false-positive rates. We suggest that fetuses with biometry results below the 25th percentile or above the 75th percentile at the onset of the third trimester of pregnancy should be more intensively investigated in order to distinguish between pathology (e.g., IUGR or macrosomia) and physiology and to decide about the appropriate level of further perinatal care.

Keywords: Effectiveness of antenatal screening; intrauterine growth restriction; large-for-gestational-age; macrosomia; prenatal care; small-for-gestational-age; ultrasound measurement

About the article

Corresponding author: Paul A.O.M. De Reu Verloskundig Centrum Midden Brabant Pelgrimspad 3 Boxtel 5281 AA The Netherlands


Received: 2007-11-28

Revised: 2008-03-22

Accepted: 2008-04-10

Published Online: 2008-07-03

Published in Print: 2008-07-01



Citation Information: Journal of Perinatal Medicine, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: https://doi.org/10.1515/JPM.2008.057. Export Citation

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