scholarly journals Consensus definition of fetal growth restriction: a Delphi procedure

2016 ◽  
Vol 48 (3) ◽  
pp. 333-339 ◽  
Author(s):  
S. J. Gordijn ◽  
I. M. Beune ◽  
B. Thilaganathan ◽  
A. Papageorghiou ◽  
A. A. Baschat ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Growth Restriction ◽  
Consensus Definition ◽  
Delphi Procedure ◽  
Definition Of

scholarly journals Consensus Definition of Fetal Growth Restriction in Intrauterine Fetal Death: A Delphi Procedure

2020 ◽  
Author(s):  
Irene Maria Beune ◽  
Stefanie Elisabeth Damhuis ◽  
Wessel Ganzevoort ◽  
John Ciaran Hutchinson ◽  
Teck Yee Khong ◽  
...  
Keyword(s):  
Birth Weight ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Fetal Death ◽  
Weight Ratio ◽  
Liver Weight ◽  
Growth Restriction ◽  
Intrauterine Fetal Death ◽  
Consensus Definition ◽  
Definition Of

Context.— Fetal growth restriction is a risk factor for intrauterine fetal death. Currently, definitions of fetal growth restriction in stillborn are heterogeneous. Objectives.— To develop a consensus definition for fetal growth restriction retrospectively diagnosed at fetal autopsy in intrauterine fetal death. Design.— A modified online Delphi survey in an international panel of experts in perinatal pathology, with feedback at group level and exclusion of nonresponders. The survey scoped all possible variables with an open question. Variables suggested by 2 or more experts were scored on a 5-point Likert scale. In subsequent rounds, inclusion of variables and thresholds were determined with a 70% level of agreement. In the final rounds, participants selected the consensus algorithm. Results.— Fifty-two experts participated in the first round; 88% (46 of 52) completed all rounds. The consensus definition included antenatal clinical diagnosis of fetal growth restriction OR a birth weight lower than third percentile OR at least 5 of 10 contributory variables (risk factors in the clinical antenatal history: birth weight lower than 10th percentile, body weight at time of autopsy lower than 10th percentile, brain weight lower than 10th percentile, foot length lower than 10th percentile, liver weight lower than 10th percentile, placental weight lower than 10th percentile, brain weight to liver weight ratio higher than 4, placental weight to birth weight ratio higher than 90th percentile, histologic or gross features of placental insufficiency/malperfusion). There was no consensus on some aspects, including how to correct for interval between fetal death and delivery. Conclusions.— A consensus-based definition of fetal growth restriction in fetal death was determined with utility to improve management and outcomes of subsequent pregnancies.

scholarly journals Temporal variation in definition of fetal growth restriction in the literature

2019 ◽  
Vol 53 (5) ◽  
pp. 569-570 ◽  
Author(s):  
I. M. Beune ◽  
A. Pels ◽  
S. J. Gordijn ◽  
W. Ganzevoort
Keyword(s):  
Temporal Variation ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Growth Restriction ◽  
Definition Of

Pathologic Basis for the Definition of Discordant Growth in Dichorionic Twins

2021 ◽  
Vol 48 (4) ◽  
pp. 279-287
Author(s):  
Eran Ashwal ◽  
Liran Hiersch ◽  
Howard Berger ◽  
Amir Aviram ◽  
Arthur Zaltz ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Growth Restriction ◽  
Adjusted Relative Risk ◽  
Placental Pathology ◽  
Specific Measure ◽  
Optimal Cutoff ◽  
Definition Of ◽  
Twin Pregnancies ◽  
Pathologic Basis

<b><i>Objective:</i></b> The aim of the current study was to identify the optimal cutoff that should define discordance in dichorionic twin gestations through correlation with abnormal placental pathology as a specific measure of fetal growth restriction of the smaller twin. <b><i>Methods:</i></b> We performed a retrospective cohort study of all women with dichorionic twin pregnancies who gave birth in a single center between 2002 and 2015. We investigated the association between the level of growth discordance and maternal vascular malperfusion (MVM) pathology in the placenta of the smaller twin, with and without adjustment for whether the smaller twin is small for gestational age (SGA). <b><i>Results:</i></b> A total of 1,198 women with dichorionic twin gestation met the study criteria. The rate of MVM pathology in the placenta of the smaller twin increased with the level of discordance and was most obvious for discordance ≥25% (rate of MVM 12.0% compared with 2.8% in cases with discordance &#x3c;10%, adjusted relative risk [aRR] 3.71, 95% confidence interval [CI] 1.97–6.99). When the analysis was adjusted for SGA of the smaller twin, discordance was independently associated with MVM pathology only when growth discordance was ≥25% (aRR 2.18, 95%-CI 1.01–4.93), while SGA was strongly associated with MVM pathology irrespective of the level of discordance. <b><i>Conclusion:</i></b> Our findings suggest that discordant growth in dichorionic twins should raise the concern of fetal growth restriction of the smaller twin, irrespective of whether the smaller twin is SGA, only when the discordance s ≥25%. The association of lower levels of discordance with abnormal placental pathology is mainly driven by the confounding effect of SGA of the smaller twin.

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