Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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Advances in Clinical and Experimental Medicine

2018, vol. 27, nr 9, September, p. 1217–1224

doi: 10.17219/acem/69347

Publication type: original article

Language: English

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Labor in pregnancies with small for gestational age suspected fetuses

Damian Warzecha1,A,B,C,D, Eliza Kobryń1,A,B,C,D, Marta Bagińska1,B,C,D, Dorota Bomba-Opoń1,A,E,F

1 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland

Abstract

Background. Fetal growth restriction (FGR) is an unclearly defined condition described as a fetal weight which is too low in relation to gestational age. It is recognized in 10–15% of singleton pregnancies and can lead to severe complications, including stillbirth. To reduce the adverse fetal and neonatal outcomes, many medical interventions are being introduced by obstetricians. These, like all medical procedures, may induce further complications, such as preterm labor and its consequences.
Objectives. The aim of this study was to assess in terms of perinatal and neonatal outcomes such management procedures as expectant monitoring, induction or elective cesarean section (ECS) in pregnancies where the fetus is suspected of being small for gestational age (SGA). There was also the goal of determining the specificity of ultrasound examination in the recognition of SGA.
Material and Methods. The single-center retrospective study was carried out among 146 patients who were prenatally suspected of having SGA pregnancies and who delivered in our hospital. Small for gestational age was defined as estimated fetal weight (EFW) in the 10th percentile or below. The output cohort was divided into 2 subgroups: group A – with antenatally confirmed hypotrophy, and group B – without antenatally confirmed hypotrophy.
Results. Out of 146 newborns suspected of being SGA, 65 had a birth weight in the 10th percentile or below, and the estimated positive predictive value of ultrasound examination amounted to 44.5%. Underweight mothers correlated with 5 times higher rates of SGA overdiagnosis. Serious neonatal complications, such as neonatal deaths, respiratory or cardiovascular dysfunctions, and admission to the neonatal intensive care unit (NICU), occurred significantly more often in confirmed SGA cases (46% vs 19% in group B, with a p-value of 0.0066, 0.0253, 0.0027, and 0.0253, respectively). The highest rate of ECS concerned patients from group A (44.6% vs 30.9% in unconfirmed samples; p = 0.04), while expectant management was more often associated with neonatal death and admission to the NICU than with elective procedures (18.2% vs 7.4% and 36.4% vs 27.8%, respectively).
Conclusion. Customized charts used during ultrasound examination, which evaluate additional parameters such as body mass index (BMI), may decrease the overdiagnosis of SGA.

Key words

small for gestational age, body mass index, fetal hypotrophy, labor induction, elective procedures

References (30)

  1. Thompson JL, Kuller JA, Rhee EH. Antenatal surveillance of fetal growth restriction. Obstet Gynecol Surv. 2012;67(9):554–565. doi: 10. 1097/OGX.0b013e31826a5c6f
  2. Dashe JS, McIntire DD, Lucas MJ, Lenovo KJ. Effects of symmetric and asymmetric fetal growth on pregnancy outcomes. Obstet Gynecol. 2000;96(3):321–327.
  3. De Jong CLD, Francis A, van Geijn HP, Gardosi J. Fetal growth rate and adverse perinatal events. Ultrasound Obstet Gynecol. 1999;13:86–89.
  4. Løhaugen GC, Østgård HF, Andreassen S, et al. Small for gestational age and intrauterine growth restriction decreases cognitive function in young adults. J Pediatr. 2013;163(2):447–453.
  5. Østgård HF, Skranes J, Martinussen M, et al. Neuropsychological deficits in young adults born small-for-gestational age (SGA) at term. J Int Neuropsychol Soc. 2014;20(3):313–323.
  6. Royal College of Obstetricians and Gynaecologists (RCOG). The investigation and management of the small-for-gestational-age fetus. London, UK: Royal College of Obstetricians and Gynaecologists (RCOG); 2013:34 (Green-top Guideline No. 31).
  7. Lausman A, Kingdom J; Maternal Fetal Medicine Committee. Intrauterine growth restriction: Screening, diagnosis, and management. J Obstet Gynaecol Can. 2013;35(8):741–748.
  8. American College of Obstetricians and Gynecologists (ACOG). ACOG Practice bulletin No. 134: fetal growth restriction. Obstet Gynecol. 2013; 121(5):1122–1133.
  9. Rekomendacje zespołu ekspertów Polskiego Towarzystwa Ginekologicznego dotyczące opieki okołoporodowej i prowadzenia porodu. Ginekol Pol. 2009;80:548–557.
  10. Ohel G, Ruach M. Perinatal outcome of idiopathic small for gestational age pregnancies at term: The effect of antenatal diagnosis. Int J Gynaecol Obstet. 1996;55(1):29–32.
  11. Phelan JP, Smith CV, Broussard P, Small M. Amniotic fluid volume assessment with the four-quadrant technique at 36–42 weeks’ gestation. J Reprod Med. 1987;32:540–542.
  12. Shanks A, Tuuli M, Schaecher C, Odibo AO, Rampersad R. Assessing the optimal definition of oligohydramnios associated with adverse neonatal outcomes. J Ultrasound Med. 2011;30:303–307.
  13. Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011–2014. NCHS. Data brief, no 219. Hyattsville, MD: National Center for Health Statistics; 2015. https://www.cdc.gov/nchs/data/databriefs/db219.pdf. Accessed January 10, 2016.
  14. Basha AS, Abu-Khader IB, Qutishat RM, Amarin ZO. Accuracy of sonographic fetal weight estimation within 14 days of delivery in a Jordanian population using Hadlock formula 1. Med Princ Pract. 2012;21(4): 366–369.
  15. Geerts L, Widmer T. Which is the most accurate formula to estimate fetal weight in women with severe preterm preeclampsia? J Matern Fetal Neonatal Med. 2011;24(2):271–279.
  16. Esinler D, Bircan O, Esin S, et al. Finding the best formula to predict the fetal weight: Comparison of 18 formulas. Gynecol Obstet Invest. 2015;80(2):78–84.
  17. Monier I, Blondel B, Ego A, Kaminiski M, Goffinet F, Zeitlin J. Poor effectiveness of antenatal detection of fetal growth restriction and consequences for obstetric management and neonatal outcomes: A French national study. BJOG. 2015;122(4):518–527.
  18. Cooper LG, Leland NL, Alexander G. Effect of maternal age on birth outcomes among young adolescents. Soc Biol. 1995;42(1–2):22–35.
  19. Schimmel MS, Bromiker R, Hammerman C, et al. The effects of maternal age and parity on maternal and neonatal outcome. Arch Gynecol Obstet. 2015;291(4):793–798.
  20. Belogolovkin V, Alio AP, Mbah AK, Clayton HB, Wathington D, Salihu HM. Patterns and success of fetal programming among women with low and extremely low pre-pregnancy BMI. Arch Gynecol Obstet. 2009;280(4):579–584.
  21. Kozuki N, Katz J, Lee AC, et al.; Child Health Epidemiology Reference Group Small-for-Gestational-Age/Preterm Birth Working Group. Short maternal stature increases risk of small-for-gestational-age and preterm births in low- and middle-income countries: Individual participant data meta-analysis and population attributable fraction. J Nutr. 2015;145(11):2542–2550.
  22. Castrillio SM, Rankin KM, David RJ, Collins JW. Small-for-gestational age and preterm birth across generations: A population-based study of Illinois births. Matern Child Health J. 2014;18(10):2456–2464.
  23. Stirnemann JJ, Benoist G, Salomon LJ, Bernard JP, Ville Y. Optimal risk assessment of small-for-gestational-age fetuses using 31–34-week biometry in a low-risk population. Ultrasound Obstet Gynecol. 2014; 43(3):311–316.
  24. Odibo AO, Francis A, Cahill AG, Macones GA, Crane JP, Gardosi J. Association between pregnancy complications and small-for-gestational-age birth weight defined by customized fetal growth standard versus a population-based standard. J Matern Fetal Neonatal Med. 2011;24(3):411–417.
  25. Papageorghiou AT, Ohuma EO, Altman DG, et al.; International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st). International standards for fetal growth based on serial ultrasound measurements: The fetal growth longitudinal study of the INTERGROWTH-21st project. Lancet. 2014;384(9946):869–879.
  26. Boers KE, Bijlenga D, Mol BWJ, et al. Disproportionate Intrauterine Growth Intervention Trial At Term: DIGITAT. BMC Pregnancy Childbirth. 2007;7:12. doi: 10.1186/1471-2393-7-12
  27. Ohel G, Ruach M. Perinatal outcome of idiopathic small for gestational age pregnancies at term: The effect of antenatal diagnosis. Int J Gynaecol Obstet. 1996;55(1):29–32.
  28. Kramer MS, Demissie K, Yang H, Platt HR, Sauve R, Liston R. The contribution of mild and moderate preterm birth to infant mortality. J Am Podiatr Med Assoc. 2000;284(7):843–849.
  29. Tomashek KM, Shapiro-Mendoza CK, Davidoff MJ, Petrini JR. Differences in mortality between late-preterm and term singleton infants in the United States, 1995–2002. J Pediatr. 2007;151(5):450–456.
  30. Boers KE, van der Post JA, Mol BW, van Lith JM, Scherjon SA. Labour and neonatal outcome in small for gestational age babies delivered beyond 36+0 weeks: A retrospective cohort study. J Pregnancy. 2011. doi: 10.1155/2011/293516
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