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McKenna M, McKenna D, Zhou M, Sonek J, Wiegand S. Prediction of Neonatal Growth Restriction in Fetuses With Gastroschisis by Early Third Trimester Ultrasonography Utilizing Contemporary Birth Weight Percentiles. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:997-1005. [PMID: 36177800 DOI: 10.1002/jum.16108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/09/2022] [Accepted: 09/10/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To identify the estimated fetal weight (EFW) formula and threshold for the optimal prediction of fetal growth restriction (FGR) at 26-34 weeks' in fetuses with gastroschisis. METHODS Late second and third trimester ultrasound data were used to calculate the EFW utilizing eight different formulas: Hadlock I-IV, Honarvar, Shepard, Siemer, and Warsof. EFW and birth weight percentiles were assigned from US population growth curves. FGR and small for gestational age (SGA) were defined as EFW and birth weight less than the tenth percentile for gestational age; Receiver operating characteristic (ROC) curves were used to compare formula performance for FGR diagnosis at 26-34 weeks' to identify an SGA birth weight. RESULTS There were 170 newborns with gastroschisis; 46 (27%) were SGA. The mean gestational age at the time of ultrasound was 30.8 ± 1.7 weeks. The mean gestational age at birth was 36.3 ± 1.7 weeks. ROC curve analysis found the Hadlock III formula had the largest area under the curve (AUC) of 0.813 closely followed by Hadlock IV (AUC = 0.811) and Hadlock II (AUC = 0.808) for diagnosis of FGR correlating to neonatal SGA diagnosis. Hadlock II, Hadlock III, and Hadlock IV had the highest diagnostic accuracies when compared to the other EFW formulas. CONCLUSIONS The Hadlock II, Hadlock III, and Hadlock IV formulas have comparable predictive performance in the optimal identification of FGR in fetuses with gastroschisis at 26-34 weeks'. A threshold of an EFW less than the 25.2th percentile is suggested.
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Affiliation(s)
- Madeline McKenna
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - David McKenna
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Wright State University Boonshoft School of Medicine, Fairborn, Ohio, USA
| | - Ming Zhou
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Wright State University Boonshoft School of Medicine, Fairborn, Ohio, USA
| | - Jiri Sonek
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Wright State University Boonshoft School of Medicine, Fairborn, Ohio, USA
| | - Samantha Wiegand
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Wright State University Boonshoft School of Medicine, Fairborn, Ohio, USA
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Fisher JE, Tolcher MC, Shamshirsaz AA, Espinoza J, Sanz Cortes M, Donepudi R, Belfort MA, Nassr AA. Accuracy of Ultrasound to Predict Neonatal Birth Weight Among Fetuses With Gastroschisis: Impact on Timing of Delivery. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1383-1389. [PMID: 33002208 DOI: 10.1002/jum.15519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/30/2020] [Accepted: 09/14/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To determine the accuracy of ultrasound estimation of fetal weight among fetuses with gastroschisis and how the diagnosis of fetal growth restriction (FGR) affects the timing of delivery. METHODS This was a retrospective cohort study including all fetuses with a diagnosis of gastroschisis at our institution from November 2012 through October 2017. We excluded multiple gestations, pregnancies with major structural or chromosomal abnormalities, and those for which prenatal and postnatal follow-up were unavailable. Performance characteristics of ultrasound to predict being small for gestational age (SGA) were calculated for the first and last ultrasound estimations of fetal weight. RESULTS Our cohort included 75 cases of gastroschisis. At the initial ultrasound estimation, 15 of 58 (25.9%) fetuses met criteria for FGR; 48 of 70 (68.6%) met criteria at the time of the last ultrasound estimation (median, 34.7 weeks). Cesarean delivery was performed for 37 of 75 (49.3%), with FGR and concern for fetal distress as the indication for delivery in 17 of 37 (45.9%). Only 6 of 17 (35.3%) of the neonates born by cesarean delivery for an indication of FGR and fetal distress were SGA. The initial ultrasound designation of FGR corresponded to SGA at birth in 8 of 15 (53.3%), whereas the last ultrasound estimation corresponded to SGA in 17 of 48 (35.4%). The initial ultrasound estimation agreed with the last ultrasound estimation before delivery with the diagnosis of FGR in 13 of 15 (86.7%). CONCLUSIONS Ultrasound in the third trimester was sensitive but had a low positive predictive value and low accuracy for the diagnosis of SGA at birth for fetuses with gastroschisis. A large proportion of fetuses were born by cesarean delivery with indications related to FGR or fetal concerns.
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Affiliation(s)
- James E Fisher
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, and Texas Children's Hospital Fetal Center, Houston, Texas, USA
| | - Mary C Tolcher
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, and Texas Children's Hospital Fetal Center, Houston, Texas, USA
| | - Alireza A Shamshirsaz
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, and Texas Children's Hospital Fetal Center, Houston, Texas, USA
| | - Jimmy Espinoza
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, and Texas Children's Hospital Fetal Center, Houston, Texas, USA
| | - Magdalena Sanz Cortes
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, and Texas Children's Hospital Fetal Center, Houston, Texas, USA
| | - Roopali Donepudi
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, and Texas Children's Hospital Fetal Center, Houston, Texas, USA
| | - Michael A Belfort
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, and Texas Children's Hospital Fetal Center, Houston, Texas, USA
| | - Ahmed A Nassr
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, and Texas Children's Hospital Fetal Center, Houston, Texas, USA
- Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Assiut, Egypt
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Dewberry LC, Hilton SA, Zaretsky MV, Behrendt N, Galan HL, Marwan AI, Liechty KW. Examination of Prenatal Sonographic Findings: Intra-Abdominal Bowel Dilation Predicts Poor Gastroschisis Outcomes. Fetal Diagn Ther 2019; 47:245-250. [PMID: 31454815 DOI: 10.1159/000501592] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/19/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Gastroschisis is an anterior abdominal wall defect with variable outcomes. There are conflicting data regarding the prognostic value of sonographic findings. OBJECTIVES The aim of this study was to identify prenatal ultrasonographic features associated with poor neonatal outcomes. METHOD A retrospective review of 55 patients with gastroschisis from 2007 to 2017 was completed. Ultrasounds were reviewed for extra-abdominal intestinal diameter (EAID) and intra-abdominal intestinal diameter (IAID), echogenicity, visceral content within the herniation, amniotic fluid index, defect size, and abdominal circumference (AC). Ultrasound variables were correlated with full enteral feeding and the diagnosis of a complex gastroschisis. RESULTS Bivariate analysis demonstrated an increased time to full enteral feeds with increasing number of surgeries, EAID, and IAID. Additionally, there was a significant relationship between IAID and AC percentile with the diagnosis of complex gastroschisis. On multivariate analysis, only IAID was significant and increasing diameter had a 2.82 (95% CI 1.02-7.78) higher odds of a longer time to full enteral feeds and a 1.2 (95% CI 1.05-1.36) greater odds of the diagnosis of a complex gastroschisis. CONCLUSIONS Based on these findings, IAID is associated with a longer time to full enteral feeding and the diagnosis of complex gastroschisis.
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Affiliation(s)
- Lindel C Dewberry
- Department of Surgery, University of Colorado, Aurora, Colorado, USA
| | - Sarah A Hilton
- Department of Surgery, University of Colorado, Aurora, Colorado, USA
| | - Michael V Zaretsky
- Colorado Fetal Care Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nicholas Behrendt
- Colorado Fetal Care Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Henry L Galan
- Colorado Fetal Care Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ahmed I Marwan
- Division of Pediatric Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA
| | - Kenneth W Liechty
- Division of Pediatric Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA,
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Heazell AE, Hayes DJ, Whitworth M, Takwoingi Y, Bayliss SE, Davenport C. Biochemical tests of placental function versus ultrasound assessment of fetal size for stillbirth and small-for-gestational-age infants. Cochrane Database Syst Rev 2019; 5:CD012245. [PMID: 31087568 PMCID: PMC6515632 DOI: 10.1002/14651858.cd012245.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Stillbirth affects 2.6 million pregnancies worldwide each year. Whilst the majority of cases occur in low- and middle-income countries, stillbirth remains an important clinical issue for high-income countries (HICs) - with both the UK and the USA reporting rates above the mean for HICs. In HICs, the most frequently reported association with stillbirth is placental dysfunction. Placental dysfunction may be evident clinically as fetal growth restriction (FGR) and small-for-dates infants. It can be caused by placental abruption or hypertensive disorders of pregnancy and many other disorders and factorsPlacental abnormalities are noted in 11% to 65% of stillbirths. Identification of FGA is difficult in utero. Small-for-gestational age (SGA), as assessed after birth, is the most commonly used surrogate measure for this outcome. The degree of SGA is associated with the likelihood of FGR; 30% of infants with a birthweight < 10th centile are thought to be FGR, while 70% of infants with a birthweight < 3rd centile are thought to be FGR. Critically, SGA is the most significant antenatal risk factor for a stillborn infant. Correct identification of SGA infants is associated with a reduction in the perinatal mortality rate. However, currently used tests, such as measurement of symphysis-fundal height, have a low reported sensitivity and specificity for the identification of SGA infants. OBJECTIVES The primary objective was to assess and compare the diagnostic accuracy of ultrasound assessment of fetal growth by estimated fetal weight (EFW) and placental biomarkers alone and in any combination used after 24 weeks of pregnancy in the identification of placental dysfunction as evidenced by either stillbirth, or birth of a SGA infant. Secondary objectives were to investigate the effect of clinical and methodological factors on test performance. SEARCH METHODS We developed full search strategies with no language or date restrictions. The following sources were searched: MEDLINE, MEDLINE In Process and Embase via Ovid, Cochrane (Wiley) CENTRAL, Science Citation Index (Web of Science), CINAHL (EBSCO) with search strategies adapted for each database as required; ISRCTN Registry, UK Clinical Trials Gateway, WHO International Clinical Trials Portal and ClinicalTrials.gov for ongoing studies; specialist abstract and conference proceeding resources (British Library's ZETOC and Web of Science Conference Proceedings Citation Index). Search last conducted in Ocober 2016. SELECTION CRITERIA We included studies of pregnant women of any age with a gestation of at least 24 weeks if relevant outcomes of pregnancy (live birth/stillbirth; SGA infant) were assessed. Studies were included irrespective of whether pregnant women were deemed to be low or high risk for complications or were of mixed populations (low and high risk). Pregnancies complicated by fetal abnormalities and multi-fetal pregnancies were excluded as they have a higher risk of stillbirth from non-placental causes. With regard to biochemical tests, we included assays performed using any technique and at any threshold used to determine test positivity. DATA COLLECTION AND ANALYSIS We extracted the numbers of true positive, false positive, false negative, and true negative test results from each study. We assessed risk of bias and applicability using the QUADAS-2 tool. Meta-analyses were performed using the hierarchical summary ROC model to estimate and compare test accuracy. MAIN RESULTS We included 91 studies that evaluated seven tests - blood tests for human placental lactogen (hPL), oestriol, placental growth factor (PlGF) and uric acid, ultrasound EFW and placental grading and urinary oestriol - in a total of 175,426 pregnant women, in which 15,471 pregnancies ended in the birth of a small baby and 740 pregnancies which ended in stillbirth. The quality of included studies was variable with most domains at low risk of bias although 59% of studies were deemed to be of unclear risk of bias for the reference standard domain. Fifty-three per cent of studies were of high concern for applicability due to inclusion of only high- or low-risk women.Using all available data for SGA (86 studies; 159,490 pregnancies involving 15,471 SGA infants), there was evidence of a difference in accuracy (P < 0.0001) between the seven tests for detecting pregnancies that are SGA at birth. Ultrasound EFW was the most accurate test for detecting SGA at birth with a diagnostic odds ratio (DOR) of 21.3 (95% CI 13.1 to 34.6); hPL was the most accurate biochemical test with a DOR of 4.78 (95% CI 3.21 to 7.13). In a hypothetical cohort of 1000 pregnant women, at the median specificity of 0.88 and median prevalence of 19%, EFW, hPL, oestriol, urinary oestriol, uric acid, PlGF and placental grading will miss 50 (95% CI 32 to 68), 116 (97 to 133), 124 (108 to 137), 127 (95 to 152), 139 (118 to 154), 144 (118 to 161), and 144 (122 to 161) SGA infants, respectively. For the detection of pregnancies ending in stillbirth (21 studies; 100,687 pregnancies involving 740 stillbirths), in an indirect comparison of the four biochemical tests, PlGF was the most accurate test with a DOR of 49.2 (95% CI 12.7 to 191). In a hypothetical cohort of 1000 pregnant women, at the median specificity of 0.78 and median prevalence of 1.7%, PlGF, hPL, urinary oestriol and uric acid will miss 2 (95% CI 0 to 4), 4 (2 to 8), 6 (6 to 7) and 8 (3 to 13) stillbirths, respectively. No studies assessed the accuracy of ultrasound EFW for detection of pregnancy ending in stillbirth. AUTHORS' CONCLUSIONS Biochemical markers of placental dysfunction used alone have insufficient accuracy to identify pregnancies ending in SGA or stillbirth. Studies combining U and placental biomarkers are needed to determine whether this approach improves diagnostic accuracy over the use of ultrasound estimation of fetal size or biochemical markers of placental dysfunction used alone. Many of the studies included in this review were carried out between 1974 and 2016. Studies of placental substances were mostly carried out before 1991 and after 2013; earlier studies may not reflect developments in test technology.
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Affiliation(s)
- Alexander Ep Heazell
- Maternal and Fetal Health Research Centre, University of Manchester, 5th floor (Research), St Mary's Hospital, Oxford Road, Manchester, UK, M13 9WL
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Goto E. Usefulness of ultrasound fetal anthropometry in primary and secondary screening to identify small for gestational age: A meta-analysis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:212-218. [PMID: 30635918 DOI: 10.1002/jcu.22688] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 10/24/2018] [Accepted: 12/27/2018] [Indexed: 06/09/2023]
Abstract
PURPOSE This study was performed to evaluate the usefulness of ultrasound fetal anthropometry in primary and secondary screening to identify small for gestational age (SGA). METHODS Ten databases, for example, PubMed (MEDLINE), were searched to include all English-language studies published since 2015 that provided true-positive and false-positive and true-negative and false-negative results of SGA identification. A bivariate diagnostic meta-analysis was performed to summarize the sensitivity and specificity as well as positive and negative likelihood ratios (PLR and NLR, respectively) of ultrasound fetal anthropometry for identification of SGA. RESULTS Sensitivity and NLR are important in primary screening. Both femur length and anthropometric formulas showed low sensitivity, although abdominal circumference showed moderate sensitivity. Abdominal circumference, femur length, and anthropometric formulas did not have sufficiently low NLR. However, specificity and PLR are important in secondary screening. Abdominal circumference, femur length, and anthropometric formulas all showed high specificity. Neither abdominal circumference nor femur length had sufficiently high PLR, but anthropometric formulas showed sufficiently high PNL. CONCLUSIONS Abdominal circumference, femur length, and anthropometric formulas are unsuitable in primary screening to identify SGA. However, anthropometric formulas, but not abdominal circumference and femur length, are useful in secondary screening to identify SGA.
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Affiliation(s)
- Eita Goto
- Department of Medicine and Public Health, Nagoya Medical Science Research Institute, Nagoya, Japan
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Barbieri MM, Bennini JR, Nomura ML, Morais SS, Surita FG. Fetal growth standards in gastroschisis: Reference values for ultrasound measurements. Prenat Diagn 2018; 37:1327-1334. [PMID: 29110317 DOI: 10.1002/pd.5179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/26/2017] [Accepted: 10/29/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The objectives of this study were to create growth curves based on ultrasonography biometric parameters of fetuses with gastroschisis, comparing them with normal growth standards, and to analyze umbilical artery (UA) Doppler velocimetry patterns. METHODS A cohort study of 72 fetuses with gastroschisis, at gestational ages between 14 and 39 weeks was designed. Mean and standard deviation were calculated, with the 5th, 10th, 50th, 90th, and 95th centiles being established for biometric parameters according to gestational age. Curves were obtained, comparing with normal reference via the Mann-Whitney test. UA Doppler velocimetry patterns were obtained. RESULTS A total of 434 examinations were performed, and centiles were established for biparietal diameter, head circumference, abdominal circumference, femur length, and estimated fetal weight. A significant difference was observed between the gastroschisis measurements when compared to control, with all curves shifted downwards. Abdominal circumference was the parameter presenting the largest difference. Estimated fetal weight was also lower, with mean difference of 256.3 ± 166.8 g for the 50th centile (P < .0001). UA Doppler velocimetry was normal in 97.5%. CONCLUSIONS Fetuses with gastroschisis show symmetrical growth deficits in the second and third trimesters, with normal UA Doppler velocimetry. These results reinforce the hypothesis that they are constitutionally smaller, yet not restricted because of placental insufficiency.
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Affiliation(s)
- Mariane Massaini Barbieri
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, São Paulo, Brazil
| | - João Renato Bennini
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, São Paulo, Brazil
| | - Marcelo Luís Nomura
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, São Paulo, Brazil
| | - Sirlei Siani Morais
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, São Paulo, Brazil
| | - Fernanda Garanhani Surita
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, São Paulo, Brazil
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Amin R, Domack A, Bartoletti J, Peterson E, Rink B, Bruggink J, Christensen M, Johnson A, Polzin W, Wagner AJ. National Practice Patterns for Prenatal Monitoring in Gastroschisis: Gastroschisis Outcomes of Delivery (GOOD) Provider Survey. Fetal Diagn Ther 2018; 45:125-130. [PMID: 29791899 DOI: 10.1159/000487541] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 02/06/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Gastroschisis is an abdominal wall defect with increasing incidence. Given the lack of surveillance guidelines among maternal-fetal medicine (MFM) specialists, this study describes current practices in gastroschisis management. MATERIALS AND METHODS An online survey was administered to MFM specialists from institutions affiliated with the North American Fetal Therapy Network (NAFTNet). Questions focused on surveillance timing, testing, findings that changed clinical management, and delivery plan. RESULTS Responses were obtained from 29/29 (100%) NAFTNet centers, comprising 143/371 (39%) providers. The majority had a regimen for antenatal surveillance in patients with stable gastroschisis (94%; 134/141). Antenatal testing began at 32 weeks for 68% (89/131) of MFM specialists. The nonstress test (55%; 72/129), biophysical profile (50%; 63/126), and amniotic fluid index (64%; 84/131) were used weekly. Estimated fetal weight (EFW) was performed monthly by 79% (103/131) of providers. At 28 weeks, abnormal EFW (77%; 97/126) and Doppler ultrasound (78%; 99/127) most frequently altered management. In stable gastroschisis, 43% (60/140) of providers delivered at 37 weeks, and 29% (40/ 140) at 39 weeks. DISCUSSION Gastroschisis management differs among NAFTNet centers, although the majority initiate surveillance at 32 weeks. Timing of delivery still requires consensus. Prospective studies are necessary to further optimize practice guidelines and patient care.
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Affiliation(s)
- Ruchi Amin
- Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin,
| | - Aaron Domack
- Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Joseph Bartoletti
- Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Erika Peterson
- Maternal Fetal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Britton Rink
- Maternal and Fetal Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jennifer Bruggink
- Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Anthony Johnson
- Maternal and Fetal Medicine, University of Texas Health Sciences Center, Houston, Texas, USA
| | - William Polzin
- Maternal and Fetal Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Amy J Wagner
- Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Blumenfeld YJ, Do S, Girsen AI, Davis AS, Hintz SR, Desai AK, Mansour T, Merritt TA, Oshiro BT, El-Sayed YY, Shamshirsaz AA, Lee HC. Utility of third trimester sonographic measurements for predicting SGA in cases of fetal gastroschisis. J Perinatol 2017; 37:498-501. [PMID: 28125100 DOI: 10.1038/jp.2016.275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/23/2016] [Accepted: 12/01/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the accuracy of different sonographic estimated fetal weight (EFW) cutoffs, and combinations of EFW and biometric measurements for predicting small for gestational age (SGA) in fetal gastroschisis. STUDY DESIGN Gastroschisis cases from two centers were included. The sensitivity, specificity, positive and negative predictive values (PPV and NPV) were calculated for different EFW cutoffs, as well as EFW and biometric measurement combinations. RESULTS Seventy gastroschisis cases were analyzed. An EFW<10% had 94% sensitivity, 43% specificity, 33% PPV and 96% NPV for SGA at delivery. Using an EFW cutoff of <5% improved the specificity to 63% and PPV to 41%, but decreased the sensitivity to 88%. Combining an abdominal circumference (AC) or femur length (FL) z-score less than -2 with the total EFW improved the specificity and PPV but decreased the sensitivity. CONCLUSION A combination of a small AC or FL along with EFW increases the specificity and PPV, but decreases the sensitivity of predicting SGA.
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Affiliation(s)
- Y J Blumenfeld
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA.,The Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - S Do
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - A I Girsen
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - A S Davis
- The Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA.,Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - S R Hintz
- The Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA.,Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - A K Desai
- Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - T Mansour
- Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - T A Merritt
- Department of Pediatrics, Division of Neonatology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - B T Oshiro
- Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Y Y El-Sayed
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA.,The Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - A A Shamshirsaz
- Department of Obstetrics & Gynecology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - H C Lee
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
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