Detection of Adverse Perinatal Outcomes at Term Delivery Using Ultrasound Estimated Percentile Weight at 35 Weeks of Gestation: Comparison of Five Fetal Growth Standards

2019 ◽  
Vol 47 (2) ◽  
pp. 104-114 ◽  
Author(s):  
Ricardo Savirón-Cornudella ◽  
Luis M. Esteban ◽  
Mauricio Tajada-Duaso ◽  
Sergio Castán-Mateo ◽  
Peña Dieste-Pérez ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Perinatal Outcomes ◽  
Growth Standards ◽  
Term Delivery ◽  
Adverse Perinatal Outcomes

scholarly journals Fetal growth standards for Chinese twin pregnancies

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jianping Chen ◽  
Jun Zhang ◽  
Yang Liu ◽  
Xing Wei ◽  
Yingjun Yang ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Perinatal Outcomes ◽  
Growth Charts ◽  
Growth Standards ◽  
Growth Standard ◽  
Adverse Perinatal Outcomes ◽  
Chinese Twins ◽  
Twin Pregnancies

Abstract Background The common use of singleton fetal growth standard to access twin growth might lead to over-monitoring and treatment. We aimed to develop fetal growth standards for Chinese twins based on ultrasound measurements, and compare it with Zhang’s and other twin fetal growth charts. Methods A cohort of uncomplicated twin pregnancies were prospectively followed in 2014–2017. Smoothed estimates of fetal growth percentiles for both monochorionic (MC) and dichorionic (DC) twins were obtained using a linear mixed model. We also created growth charts for twins using a model-based approach proposed by Zhang et al. Our twin standards were compared with Hadlock’s (singleton) in predicting adverse perinatal outcomes. Results A total of 398 twin pregnancies were included, with 214 MC and 582 DC live-born twins. The MC twins were slightly lighter than the DC twins, with small differences throughout the gestation. Our ultrasound-based fetal weight standards were comparable to that using Zhang’s method. Compared with previous references/standards from the US, Brazil, Italy and UK, our twins had very similar 50th percentiles, but narrower ranges between the 5th and 95th or 10th and 90th percentiles. Compared with the Hadlock’s standard, the risks of neonatal death and adverse perinatal outcomes for small for gestational age (SGA) versus non-SGA were substantially elevated using our standards. Conclusions A normal fetal growth standard for Chinese twins was created. The differences between MC and DC twins were clinically insignificant. The 50th weight percentiles of the Chinese twins were identical to those in other races/ethnicities but the ranges were markedly narrower. Our standard performed much better than the Hadlock’s in predicting low birth weight infants associated with adverse perinatal outcomes in twin pregnancies. The present study also indicated that Zhang’s method is applicable to Chinese twins, and other areas may use Zhang’s method to generate their own curves for twins if deemed necessary.

High-Grade Fetal Vascular Malperfusion Is Associated With Diffuse Chorionic Hemosiderosis

2021 ◽  
pp. 109352662110646
Author(s):  
Eoghan E. Mooney ◽  
Emma Crotty
Keyword(s):  
Perinatal Outcomes ◽  
Low Grade ◽  
High Grade ◽  
Third Trimester ◽  
The Third ◽  
Term Delivery ◽  
Venous Bleeding ◽  
Placental Membranes ◽  
Adverse Perinatal Outcomes ◽  
Cord Length

Introduction Diffuse chorionic hemosiderosis (DCH) is an abnormality of the placental membranes characterized by the deposition of iron pigment. It is usually secondary to recurrent venous bleeding in early pregnancy. In many papers, it is associated with pre-term delivery. Fetal vascular malperfusion (FVM) is an abnormality of the feto-placental circulation that may be seen at any stage of gestation, but most often in the third trimester. It may be graded as low grade (LGFVM) or high grade (HGFVM). No link has been identified in the placental literature between DCH and FVM, but we have noted the 2 co-existing in placentas submitted for analysis. This study explored a possible association of these 2 entities. Methods Laboratory records were searched for singleton cases coded as DCH based on diagnosis on H&E stain over a 6-year period. Of 4478 placentas reported, 66 cases were coded as DCH (1.5%). These were classified as showing HGFVM, LGFVM, or no FVM. Controls (n = 132) were gestational age-matched cases without DCH. Cord length, coiling, insertion, or other abnormalities were noted. Membranes were classified as normal or circumvallate. Results were analyzed using Graphpad. Results Gestation ranged between 16 and 41 weeks gestation. 14/66 (21%) cases of DCH showed HGFVM and 2/66 (3%) showed LGFVM. 16/132 (12%) controls showed HGFVM and 21/132 (15.9%) had LGFVM. Where FVM is present, high-grade FVM is significantly associated with DCH versus controls ( P < .0031 Fischer’s Test). Discussion HGFVM occurs significantly more often in placentas with DCH than in controls. Both FVM and DCH are associated with adverse perinatal outcomes, and a possible relationship between the 2 remains to be clarified.

scholarly journals Perinatal Outcomes of Fetuses with Early Growth Restriction, Late Growth Restriction, Small for Gestational Age, and Adequate for Gestational Age

2019 ◽  
Vol 41 (12) ◽  
pp. 688-696
Author(s):  
Quênya Antunes Silveira Inácio ◽  
Edward Araujo Júnior ◽  
Luciano Marcondes Machado Nardozza ◽  
Caetano Galvão Petrini ◽  
Victor Paranaíba Campos ◽  
...  
Keyword(s):  
Respiratory Distress ◽  
Fetal Growth ◽  
Gestational Age ◽  
Late Onset ◽  
Neonatal Resuscitation ◽  
Perinatal Outcomes ◽  
Growth Restriction ◽  
Adverse Perinatal Outcomes ◽  
Gestational Age At Birth ◽  
Age At Birth

Abstract Objective To evaluate the association between early-onset fetal growth restriction (FGR), late-onset FGR, small for gestational age (SGA) and adequate for gestational age (AGA) fetuses and adverse perinatal outcomes. Methods This was a retrospective longitudinal study in which 4 groups were evaluated: 1 — early-onset FGR (before 32 weeks) (n = 20), 2 — late-onset FGR (at or after 32 weeks) (n = 113), 3 — SGA (n = 59), 4 — AGA (n = 476). The Kaplan-Meier curve was used to compare the time from the diagnosis of FGR to birth. Logistic regression was used to determine the best predictors of adverse perinatal outcomes in fetuses with FGR and SGA. Results A longer time between the diagnosis and birth was observed for AGA than for late FGR fetuses (p < 0.001). The model including the type of FGR and the gestational age at birth was significant in predicting the risk of hospitalization in the neonatal intensive care unit (ICU) (p < 0.001). The model including only the type of FGR predicted the risk of needing neonatal resuscitation (p < 0.001), of respiratory distress (p < 0.001), and of birth at < 32, 34, and 37 weeks of gestation, respectively (p < 0.001). Conclusion Fetal growth restriction and SGA were associated with adverse perinatal outcomes. The type of FGR at the moment of diagnosis was an independent variable to predict respiratory distress and the need for neonatal resuscitation. The model including both the type of FGR and the gestational age at birth predicted the risk of needing neonatal ICU hospitalization.

scholarly journals Which growth standards should be used to identify large- and small-for-gestational age infants of mothers with type 1 diabetes? A pre-specified analysis of the CONCEPTT trial

2020 ◽  
Author(s):  
Claire L Meek ◽  
Rosa Corcoy ◽  
Elizabeth Asztalos ◽  
Laura Caroline Kusinski ◽  
Esther Lopez ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Fetal Growth ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Perinatal Outcomes ◽  
Neonatal Hypoglycaemia ◽  
Growth Standards ◽  
Who Standards ◽  
Nicu Admission

Abstract Background Offspring of women with type 1 diabetes are at increased risk of accelerated fetal growth which is associated with perinatal morbidity. Growth standards are used to identify large- or small- for gestational age (LGA, SGA) infants. Our aim was to examine which growth standards identify infants at risk of perinatal complications during the Continuous Glucose Monitoring in Type 1 Diabetes Pregnancy Trial (CONCEPTT). Methods This was a pre-specified analysis of CONCEPTT involving 225 pregnant women from 31 international centres. Infants were weighed immediately at birth and GROW, INTERGROWTH and WHO centiles calculated. Unadjusted logistic regression identified the associations between different growth standards and perinatal outcomes including preterm delivery, Caesarean delivery, neonatal hypoglycaemia, hyperbilirubinaemia, respiratory distress, neonatal intensive care unit (NICU) admission and a composite neonatal outcome. Results Accelerated fetal growth was common, with mean birthweight percentiles of 82.1, 85.7 and 63.9 and LGA rates of 62%, 67% and 30% using GROW, INTERGROWTH and WHO standards respectively. Corresponding rates of SGA were 2.2%, 1.3% and 8.9% respectively. All standards were associated with some but not all perinatal outcomes studied. Infants born >97.7 th centile were at highest risk of complications. Conclusions WHO standards underestimated birthweight centile. GROW and INTERGROWTH standards identified similar numbers of infants as LGA and SGA with GROW showing stronger associations with neonatal hypoglycaemia, hyperbilirubinaemia and NICU admission. Infants with suspected birthweight >97.7th centile according to any standard may require extra surveillance. Definitions of LGA and SGA should be re-evaluated in diabetic pregnancy.

scholarly journals Perinatal Adverse Effects in Newborns with Estimated Loss of Weight Percentile between the Third Trimester Ultrasound and Delivery. The GROWIN Study

2021 ◽  
Vol 10 (20) ◽  
pp. 4643
Author(s):  
María Sonsoles Galán Arévalo ◽  
Ignacio Mahillo-Fernández ◽  
Luis Mariano Esteban ◽  
Mercedes Andeyro-García ◽  
Roi Piñeiro Pérez ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Gestational Age ◽  
Perinatal Outcomes ◽  
Late Gestation ◽  
Third Trimester ◽  
Loss Of Weight ◽  
Increased Risk ◽  
Appropriate For Gestational Age ◽  
Adverse Perinatal Outcomes ◽  
Weight Percentile

Fetal growth restriction has been associated with an increased risk of adverse perinatal outcomes (APOs). We determined the importance of fetal growth detention (FGD) in late gestation for the occurrence of APOs in small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) newborns. For this purpose, we analyzed a retrospective cohort study of 1067 singleton pregnancies. The newborns with higher APOs were SGA non-FGD and SGA FGD in 40.9% and 31.5% of cases, respectively, and we found an association between SGA non-FGD and any APO (OR 2.61; 95% CI: 1.35–4.99; p = 0.004). We did not find an increased APO risk in AGA FGD newborns (OR: 1.13, 95% CI: 0.80, 1.59; p = 0.483), except for cesarean delivery for non-reassuring fetal status (NRFS) with a decrease in percentile cutoff greater than 40 (RR: 2.41, 95% CI: 1.11–5.21) and 50 (RR: 2.93, 95% CI: 1.14–7.54). Conclusions: Newborns with the highest probability of APOs are SGA non-FGDs. AGA FGD newborns do not have a higher incidence of APOs than AGA non-FGDs, although with falls in percentile cutoff over 40, they have an increased risk of cesarean section due to NRFS. Further studies are warranted to detect these newborns who would benefit from close surveillance in late gestation and at delivery.

scholarly journals Which growth standards should be used to identify large- and small-for-gestational age infants of mothers with type 1 diabetes? A pre-specified analysis of the CONCEPTT trial

2020 ◽  
Author(s):  
Claire L Meek ◽  
Rosa Corcoy ◽  
Elizabeth Asztalos ◽  
Laura Caroline Kusinski ◽  
Esther Lopez ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Fetal Growth ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Perinatal Outcomes ◽  
Neonatal Hypoglycaemia ◽  
Growth Standards ◽  
Who Standards ◽  
Nicu Admission

Abstract Background Offspring of women with type 1 diabetes are at increased risk of fetal growth patterns which are associated with perinatal morbidity. Our aim was to compare rates of large- and small-for-gestational age (LGA; SGA) defined according to different criteria, using data from the Continuous Glucose Monitoring in Type 1 Diabetes Pregnancy Trial (CONCEPTT).Methods This was a pre-specified analysis of CONCEPTT involving 225 pregnant women and liveborn infants from 31 international centres. Infants were weighed immediately at birth and GROW, INTERGROWTH and WHO centiles were calculated. Relative risk ratios, sensitivity and specificity were used to assess the different growth standards with respect to perinatal outcomes, including neonatal hypoglycaemia, hyperbilirubinaemia, respiratory distress, neonatal intensive care unit (NICU) admission and a composite neonatal outcome. Results Accelerated fetal growth was common, with mean birthweight percentiles of 82.1, 85.7 and 63.9 and LGA rates of 62%, 67% and 30% using GROW, INTERGROWTH and WHO standards respectively. Corresponding rates of SGA were 2.2%, 1.3% and 8.9% respectively. LGA defined according to GROW centiles showed stronger associations with preterm delivery, neonatal hypoglycaemia, hyperbilirubinaemia and NICU admission. Infants born >97.7th centile were at highest risk of complications. SGA defined according to INTERGROWTH centiles showed slightly stronger associations with perinatal outcomes. Conclusions GROW and INTERGROWTH standards performed similarly and identified similar numbers of neonates with LGA and SGA. GROW-defined LGA and INTERGROWTH-defined SGA had slightly stronger associations with neonatal complications. WHO standards underestimated size in preterm infants and are less applicable for use in type 1 diabetes.Trial registration: This trial is registered with ClinicalTrials.gov. number NCT01788527.

scholarly journals 721: Sonographic determinants of adverse perinatal outcomes at longitudinal surveillance in late-onset fetal growth restriction

2020 ◽  
Vol 222 (1) ◽  
pp. S457
Author(s):  
Andrea Dall'Asta ◽  
Tullio Ghi ◽  
Giuseppe Pedrazzi ◽  
Enrica Roletti ◽  
Monica Minopoli ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Late Onset ◽  
Perinatal Outcomes ◽  
Growth Restriction ◽  
Adverse Perinatal Outcomes

scholarly journals Asthma in pregnancy – from immunology to clinical management

2010 ◽  
Vol 5 ◽  
Author(s):  
Lilla Tamási ◽  
Anikó Bohács ◽  
Ildikó Horváth ◽  
György Losonczy
Keyword(s):  
Fetal Growth ◽  
Clinical Management ◽  
Perinatal Outcomes ◽  
Asthma Severity ◽  
Chronic Medical Conditions ◽  
Uncontrolled Asthma ◽  
Immunological Mechanisms ◽  
Fetal Complications ◽  
Adverse Perinatal Outcomes ◽  
In Pregnancy

Asthma is one of the most common chronic medical conditions that may complicate pregnancy. Asthma influences the outcome of pregnancy and, vice versa, pregnancy affects asthma severity, but the underlying immunological mechanisms of this interaction are not fully understood. As a sign of pregnancy-induced immunotolerance, attenuation of allergic responses can be detected in controlled asthmatic pregnant patients; however non controlled asthmatic pregnant women show significant asthma-associated immune reactions that may, beside other factors, influence fetal growth. Generally, although uncontrolled asthma may increase the risk of adverse perinatal outcomes, women with well-controlled and adequately treated disease during pregnancy do not develop maternal or fetal complications.

Adverse perinatal outcomes in fetuses with severe late-onset fetal growth restriction

2021 ◽  
pp. 1-7
Author(s):  
Maria Luiza Rozo Bahia ◽  
Guillermo Coca Velarde ◽  
Fernanda Campos da Silva ◽  
Edward Araujo Júnior ◽  
Renato Augusto Moreira de Sá
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Late Onset ◽  
Perinatal Outcomes ◽  
Growth Restriction ◽  
Adverse Perinatal Outcomes

Obstetric and pediatric growth charts for the detection of late-onset fetal growth restriction and neonatal adverse outcomes

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Beatriz Fernandez-Rodriguez ◽  
Concepción de Alba ◽  
Alberto Galindo ◽  
David Recio ◽  
Cecilia Villalain ◽  
...  
Keyword(s):  
Prenatal Diagnosis ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Late Onset ◽  
Perinatal Outcomes ◽  
Adverse Outcomes ◽  
Growth Restriction ◽  
Growth Standards ◽  
Postnatal Diagnosis ◽  
Increased Risk

AbstractObjectivesLate-onset fetal growth restriction (FGR) has heterogeneous prenatal and postnatal diagnostic criteria. We compared the prenatal and postnatal diagnosis of late-onset FGR and their ability to predict adverse perinatal outcomes.MethodsRetrospective cohort study of 5442 consecutive singleton pregnancies that delivered beyond 34 + 0 weeks. Prenatal diagnosis of FGR was based on customized fetal growth standards and fetal Doppler while postnatal diagnosis was based on a birthweight <3rd percentile according to newborn charts (Olsen’s charts and Intergrowth 21st century programme). Perinatal outcomes were analyzed depending on whether the diagnosis was prenatal, postnatal or both.ResultsA total of 94 out of 5442 (1.7%) were diagnosed as late-onset FGR prenatally. Olsen’s chart and Intergrowth 21st chart detected that 125/5442 (2.3%) and 106/5442 (2.0%) of infants had a birthweight <3rd percentile, respectively. These charts identified 35/94 (37.2%) and 40/94 (42.6%) of the newborns with a prenatal diagnosis of late-onset FGR. Prenatally diagnosed late-onset FGR infants were at a higher risk for hypoglycemia, jaundice and polycythemia. Both prenatally and postnatally diagnosed as late-onset FGR had a higher risk for respiratory distress syndrome when compared to non-FGR. The higher risks for intensive care admission and composite adverse outcomes were observed in those with a prenatal diagnosis of late-onset FGR that was confirmed after birth.ConclusionsCurrent definitions of pre- and postnatal late-onset FGR do not match in more than half of cases. Infants with a prenatal or postnatal diagnosis of this condition have an increased risk of neonatal morbidity even if these diagnoses are not coincident.

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