PhenX Toolkit:
|About the Measure |
|Domain |Pregnancy |
|Measure |International Fetal Growth Standards |
|Definition |This measure includes abstraction of fetal growth and ultrasound information from a medical record. |
|About the Protocol |
|Description of Protocol |Determination of fetal growth is a three-step process: |
| |Step 1: Ascertainment of Estimated Fetal Weight (EFW) |
| |Step 2: Verification of Gestational Age (GA) at which the EFW was recorded |
| |Step 3: Determination of EFW or biometry percentiles by plotting the EFW or relevant biometric measures |
| |at the appropriate GA on a pre-defined fetal growth curve. |
|Protocol Text |Ascertainment of Estimated Fetal Weight (EFW) |
| | |
| |The investigator is encouraged to utilize one of the following approaches for documentation of EFW. |
| |Approach (a) is the preferred approach for retrospective studies, although it is recognized that |
| |biometric data may be less easily accessible in retrospective investigations, and as such approach (b) |
| |is provided as an alternative. |
| | |
| |(a) EFW (preferably in grams) derived by review of available ultrasound reports to obtain relevant |
| |biometric measures (bi-parietal diameter [BPD], head circumference [HC], abdominal circumference [AC], |
| |and femur length [FL]), followed by calculation of EFW from formula provided by Hadlock*. |
| | |
| |Date of ultrasound: ____________________ (DD/MMM/YYYY) |
| |Gestational Age: ________ weeks ________ days (as per protocol for GA) |
| |Biometric measures as they appear on the ultrasound report: |
| |Bi-parietal diameter (BPD): __________ mm |
| |Head circumference (HC): ___________ mm |
| |Abdominal circumference (AC): ___________ mm |
| |Femur length (FL): ___________ mm |
| |Estimated Fetal Weight (EFW): ________________ grams |
| | |
| |(b) EFW (preferably in grams) abstracted from ultrasound report contained within the medical record: |
| | |
| |Date of ultrasound: ____________________ (DD/MMM/YYYY) |
| |Gestational Age: ________ weeks ________ days (as per protocol for GA) |
| | |
| |Estimated Fetal Weight: ________________ grams |
| | |
| |Verification of Gestational Age (GA) |
| | |
| |See the PhenX measure for Gestational Age – Medical Record Abstraction. It is considered essential for |
| |interpretation of this measure. |
| | |
| |Plotting the EFW or Biometric Measures – International standards |
| | |
| |Determination of fetal growth should then be undertaken, by plotting EFW or biometric measures on a |
| |growth curve, allowing for determination of percentiles, by using the following protocol: |
| | |
| |INTERGROWTH-21st – Fetal Growth Longitudinal Study (FGLS) |
| | |
| |*An SR of 11 methods of EFW assessment did not identify a superior formula; given that Hadlock (1985) is|
| |the most widely used formula, it may provide the greatest degree of consistency across studies |
| | |
| |Once biometric measures and gestational age have been obtained using one of the approaches described, |
| |the investigator should consult the EFW centiles in the INTERGROWTH-21st Fetal Growth Standards Project.|
|Participant |Pregnant women |
|Rationale for Inclusion in |The INTERGROWTH 21st Project investigators conducted a prospective population-based study in eight |
|Supplemental Information |diverse locations to develop international fetal growth standards that are endorsed by the World Health |
| |Organization (WHO). The standards are based on the pooled data from those eight populations and do not |
| |represent the ethnic diversity of the U.S. |
|Source |Stirnemann, J., Villar, J., Salomon, L. J., Ohuma, E., Ruyan, P., Altman, D. G., Nosten, F., Craik, R., |
| |Munim, S., Cheikh Ismail, L., Barros, F. C., Lambert, A., Norris, S., Carvalho, M., Jaffer, Y. A., |
| |Noble, J. A., Bertino, E., Gravett, M. G., Purwar, M., Victora, C., Uauy, R., Bhutta, Z., Kennedy, S., |
| |Papageorghiou, A. T. (2016). International Estimated Fetal Weight Standards of the INTERGROWTH-21st |
| |Project. Ultrasound Obstet Gynecol. doi: 10.1002/uog.17347 |
| | |
| |Hadlock FP, Harrist RB, Sharman RS, Deter RL, Park SK. (1985). Estimation of fetal weight using head, |
| |body and femur measurements - a prospective study. Am J Obstet Gynecol, 151:333-337. |
|Language of Source |English |
|Personnel and Training Required |Personnel who are trained in performing medical records review |
|Equipment Needs |None |
|Protocol Type |Medical Record Abstraction |
|General References |Anderson, N. H., et al. (2016). INTERGROWTH-21st vs customized birthweight standards for identification |
| |of perinatal mortality and morbidity. Am J Obstet Gynecol, 214(4): 509.e501-507. |
| | |
| |Bricker L, Neilson JP, Dowswell T. (2008). Routine ultrasound in late |
| |pregnancy (after 24 weeks’ gestation). Cochrane Database Syst Rev, 4: CD001451. |
| | |
| |Conde-Agudelo A, Papageorghiou AT, Kennedy SH, Villar J. (2013). Novel biomarkers for predicting |
| |intrauterine growth restriction: a |
| |systematic review and meta-analysis. BJOG, 120:681–94. |
| | |
| |Ioannou C, Talbot K, Ohuma E, et al. (2012). Systematic review of |
| |methodology used in ultrasound studies aimed at creating charts of |
| |fetal size. BJOG, 119:1425–39. |
| | |
| |Malone FD, Canick JA, et al. (2005). First- and Second-Trimester Evalution of Risk (FASTER) Research |
| |Consortium. First-trimester or second-trimester screening, or both, for Down’s Syndrome. N Engl J Med, |
| |353(19):2001-11. |
| | |
| |Sylvan K, Ryding EL, Rydhstroem H. (2005). Routine ultrasound screening in the third trimester: a |
| |population-based study. |
| |Acta Obstet Gynecol Scand, 84: 1154–58. |
|Process and Review |The Expert Review Panel has not reviewed this measure yet. |
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