Livrepository.liverpool.ac.uk
Diagnostic accuracy of individual antenatal tools for the detection of the small for gestational age newborn.Borna POLJAK1.Umber AGARWAL, MD2. Richard JACKSON, PhD3.Zarko ALFIREVIC, MD1, Andrew SHARP, PhD1Affiliations:Department of Women’s and Children’s Health Research, University Department, Liverpool Women’s Hospital, Crown Street, Liverpool, L8 7SS, UK.Fetal Medicine Unit, Liverpool Women’s Hospital, Crown Street, Liverpool, L8 7SS, UK.Liverpool Cancer Trials Unit, 1-3 Brownlow St, Liverpool L69 3GLCorrespondence:Dr Andrew SharpDepartment of Women’s and Children’s Health Research, Liverpool Women’s Hospital Crown Street, Liverpool, L8 7SS, United Kingdom.Tel: +44 151 795 9560Email: asharp@liv.ac.ukAbstractObjectiveTo define the accuracy of fetal and newborn growth charts for the detection of small for gestational age (SGA) fetuses (<10th centile).DesignProspective cohort study.SettingUK specialist fetal growth clinic.Population or Sample105 consecutive pregnant women referred with a fetus suspected of being SGA. MethodsAll pregnancies were managed according to a standard protocol using estimated fetal weight (EFW) plotted on customised GROW charts. Last antenatal estimate of EFW (GROW, Mikolayczyk), abdominal circumference (AC Hadlock, Ig-21, AC Chitty) or change in AC over time (POP study) was compared to 4 birthweight charts (GROW, Ig-21, Mikolayczyk, WHO) and to APO. Main Outcome Measures?Birthweight <10th centile.Results?GROW defined 62 babies as having a birth weight <10th centile (59%), 57 babies using Mikolayczyk (54%), 55 babies using Ig-21 (52%) and 51 babies using WHO (48.6%). AC (Hadlock) had the best LR- (0.3-0.4) and best sensitivity for detecting SGA as defined by all 4 postnatal birthweight charts (74% - 82%). AC Ig-21 had the best LR+ (5.9-10.9) and specificity (94%-96%).For adverse perinatal outcome (APO), AC (Hadlock) and EFW (GROW) had the best sensitivity (57% and 52%), whilst AC (POP) had the best LR+ (2.2) and best specificity (88%). APO detection increased to a sensitivity of 61% when AC (POP) and EFW <10th centile were combined but specificity was only 56%.ConclusionsWe have identified a wide variation in the diagnostic accuracy of various tests for the detection of both SGA and APO dependent upon choice of chart. Suboptimal diagnostic accuracy of commonly used antenatal tests may lead to increasing medicalisation without preventing APO. Researchers should focus their attention on a combination of fetal biometry and biomarkers for better detection of SGA and prevention of APO.Keywordsfetal growth restriction, small for gestational age, ultrasound prediction.IntroductionThere has been a growing drive to identify more accurately the fetus that is small for gestational age (SGA). Detection of the SGA fetus is intended to allow monitoring for pathological deterioration in fetal condition as part of intrauterine fetal growth restriction (IUGR) characterised by abnormal fetal Dopplers PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYXJjb25pPC9BdXRob3I+PFllYXI+MjAwODwvWWVhcj48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==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYXJjb25pPC9BdXRob3I+PFllYXI+MjAwODwvWWVhcj48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==
ADDIN EN.CITE.DATA 1, which may occur as a prelude to term stillbirth ADDIN EN.CITE <EndNote><Cite><Author>Gardosi</Author><Year>2005</Year><RecNum>2</RecNum><DisplayText><style face="superscript">2</style></DisplayText><record><rec-number>2</rec-number><foreign-keys><key app="EN" db-id="ee5sr0epbw0dzpevtw3vte2hswx0adtdv59v" timestamp="1468334875">2</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gardosi, J.</author><author>Kady, S. M.</author><author>McGeown, P.</author><author>Francis, A.</author><author>Tonks, A.</author></authors></contributors><auth-address>Perinatal Institute, Birmingham B6 5RQ. gardosi@perinatal.nhs.uk</auth-address><titles><title>Classification of stillbirth by relevant condition at death (ReCoDe): population based cohort study</title><secondary-title>BMJ</secondary-title></titles><periodical><full-title>BMJ</full-title></periodical><pages>1113-7</pages><volume>331</volume><number>7525</number><edition>2005/10/21</edition><keywords><keyword>Birth Weight</keyword><keyword>Cause of Death</keyword><keyword>Classification/*methods</keyword><keyword>Cohort Studies</keyword><keyword>England/epidemiology</keyword><keyword>Female</keyword><keyword>Fetal Death/epidemiology/*etiology</keyword><keyword>Gestational Age</keyword><keyword>Humans</keyword><keyword>Pregnancy</keyword><keyword>*Stillbirth</keyword></keywords><dates><year>2005</year><pub-dates><date>Nov 12</date></pub-dates></dates><isbn>1756-1833 (Electronic)
0959-535X (Linking)</isbn><accession-num>16236774</accession-num><urls><related-urls><url> [pii]
10.1136/bmj.38629.587639.7C</electronic-resource-num><language>eng</language></record></Cite></EndNote>2. This is of particular importance in the UK, where stillbirth rates have recently been identified as being amongst the worst in developed countries ADDIN EN.CITE <EndNote><Cite><Author>Flenady</Author><Year>2011</Year><RecNum>3</RecNum><DisplayText><style face="superscript">3</style></DisplayText><record><rec-number>3</rec-number><foreign-keys><key app="EN" db-id="ee5sr0epbw0dzpevtw3vte2hswx0adtdv59v" timestamp="1468334875">3</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Flenady, V.</author><author>Koopmans, L.</author><author>Middleton, P.</author><author>Froen, J. F.</author><author>Smith, G. C.</author><author>Gibbons, K.</author><author>Coory, M.</author><author>Gordon, A.</author><author>Ellwood, D.</author><author>McIntyre, H. D.</author><author>Fretts, R.</author><author>Ezzati, M.</author></authors></contributors><auth-address>Mater Medical Research Institute, South Brisbane, QLD, Australia. vicki.flenady@mmri..au</auth-address><titles><title>Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis</title><secondary-title>Lancet</secondary-title></titles><periodical><full-title>Lancet</full-title></periodical><pages>1331-40</pages><volume>377</volume><number>9774</number><edition>2011/04/19</edition><keywords><keyword>Developed Countries</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Pregnancy</keyword><keyword>Risk Factors</keyword><keyword>Socioeconomic Factors</keyword><keyword>Stillbirth/*epidemiology</keyword></keywords><dates><year>2011</year><pub-dates><date>Apr 16</date></pub-dates></dates><isbn>1474-547X (Electronic)
0140-6736 (Linking)</isbn><accession-num>21496916</accession-num><urls><related-urls><url>(10)62233-7
S0140-6736(10)62233-7 [pii]</electronic-resource-num><language>eng</language></record></Cite></EndNote>3.Within the UK screening for the SGA fetus relies upon measurement of the symphysial fundal height (SFH), plotted against population charts ADDIN EN.CITE <EndNote><Cite><Author>NICE</Author><Year>2008</Year><RecNum>4</RecNum><DisplayText><style face="superscript">4</style></DisplayText><record><rec-number>4</rec-number><foreign-keys><key app="EN" db-id="ee5sr0epbw0dzpevtw3vte2hswx0adtdv59v" timestamp="1468334875">4</key></foreign-keys><ref-type name="Government Document">46</ref-type><contributors><authors><author>NICE</author></authors></contributors><titles><title>Antenatal care: Routine care for the healthy pregnant woman</title></titles><volume>CG 62</volume><dates><year>2008</year></dates><pub-location>London</pub-location><publisher>National Institute of Health and Clinical Excellence</publisher><urls></urls></record></Cite></EndNote>4 or customised charts in an attempt to increase the sensitivity of this technique ADDIN EN.CITE <EndNote><Cite><Author>RCOG</Author><Year>2013</Year><RecNum>5</RecNum><DisplayText><style face="superscript">5</style></DisplayText><record><rec-number>5</rec-number><foreign-keys><key app="EN" db-id="ee5sr0epbw0dzpevtw3vte2hswx0adtdv59v" timestamp="1468334875">5</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>RCOG</author></authors></contributors><titles><title>The investigation and management of the small-for-gestational-age fetus</title><secondary-title>Green-top guideline No.31</secondary-title></titles><periodical><full-title>Green-top guideline No.31</full-title></periodical><dates><year>2013</year></dates><urls></urls></record></Cite></EndNote>5, however the detection rates remain poor ADDIN EN.CITE <EndNote><Cite><Author>Neilson</Author><Year>2000</Year><RecNum>6</RecNum><DisplayText><style face="superscript">6</style></DisplayText><record><rec-number>6</rec-number><foreign-keys><key app="EN" db-id="ee5sr0epbw0dzpevtw3vte2hswx0adtdv59v" timestamp="1468334876">6</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Neilson, J. P.</author></authors></contributors><auth-address>Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool, UK, L69 3BX. jneilson@liverpool.ac.uk</auth-address><titles><title>Symphysis-fundal height measurement in pregnancy</title><secondary-title>Cochrane Database Syst Rev</secondary-title></titles><periodical><full-title>Cochrane Database Syst Rev</full-title></periodical><pages>CD000944</pages><number>2</number><edition>2000/05/05</edition><keywords><keyword>*Anthropometry</keyword><keyword>*Embryonic and Fetal Development</keyword><keyword>Female</keyword><keyword>Gastric Fundus</keyword><keyword>Humans</keyword><keyword>Pregnancy</keyword><keyword>Pubic Symphysis</keyword></keywords><dates><year>2000</year></dates><isbn>1469-493X (Electronic)
1361-6137 (Linking)</isbn><accession-num>10796225</accession-num><urls><related-urls><url> [pii]
10.1002/14651858.CD000944</electronic-resource-num><language>eng</language></record></Cite></EndNote>6. If this primary screening raises a concerns about the possibility of an SGA fetus the woman will be referred for an ultrasound assessment. Screening using third trimester ultrasound is an obvious alternative, but the timing of the scan ADDIN EN.CITE <EndNote><Cite><Author>Roma</Author><Year>2015</Year><RecNum>7</RecNum><DisplayText><style face="superscript">7</style></DisplayText><record><rec-number>7</rec-number><foreign-keys><key app="EN" db-id="ee5sr0epbw0dzpevtw3vte2hswx0adtdv59v" timestamp="1468334876">7</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Roma, E.</author><author>Arnau, A.</author><author>Berdala, R.</author><author>Bergos, C.</author><author>Montesinos, J.</author><author>Figueras, F.</author></authors></contributors><auth-address>Obstetrics and Gynecology Department, Althaia, Network Healthcare Manresa Foundation, Barcelona, Spain.
Research and Innovation Unit, Althaia, Network Healthcare Manresa Foundation, Barcelona, Spain.
BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clinic and Hospital Sant Joan de Deu, IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.</auth-address><titles><title>Ultrasound screening for fetal growth restriction at 36 vs 32 weeks' gestation: a randomized trial (ROUTE)</title><secondary-title>Ultrasound Obstet Gynecol</secondary-title></titles><periodical><full-title>Ultrasound Obstet Gynecol</full-title></periodical><pages>391-7</pages><volume>46</volume><number>4</number><edition>2015/06/03</edition><dates><year>2015</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>1469-0705 (Electronic)
0960-7692 (Linking)</isbn><accession-num>26031399</accession-num><urls><related-urls><url> and its cost effectiveness remain controversial ADDIN EN.CITE <EndNote><Cite><Author>NICE</Author><Year>2008</Year><RecNum>8</RecNum><DisplayText><style face="superscript">8</style></DisplayText><record><rec-number>8</rec-number><foreign-keys><key app="EN" db-id="ee5sr0epbw0dzpevtw3vte2hswx0adtdv59v" timestamp="1468334876">8</key></foreign-keys><ref-type name="Electronic Book">44</ref-type><contributors><authors><author>NICE</author></authors></contributors><titles><title>Antenatal care routine care for the healthy pregnant woman (CG62)</title><secondary-title>National Institute for Clinical Excellence</secondary-title><tertiary-title>Clinical Guideline</tertiary-title></titles><section> 26th November 2012</access-date></record></Cite></EndNote>8. Also, it has been suggested that without the use of additional biomarkers these scans may be inefficient at predicting and preventing adverse perinatal outcome (APO) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Ucml1bmZvPC9BdXRob3I+PFllYXI+MjAxNTwvWWVhcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Ucml1bmZvPC9BdXRob3I+PFllYXI+MjAxNTwvWWVhcj48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ADDIN EN.CITE.DATA 9, 10. Antenatal ultrasound detection of SGA based on abdominal circumference (AC) and estimated fetal weight (EFW) is far from straightforward, because these well defined parameters are estimated using a multitude of mathematical calculations that may give varying results for the same fetus. To further complicate matters, obtained results can then be plotted on a number of different antenatal reference charts generated from local, national or international cohorts some of which are customised for maternal factors, such as; parity, height, weight and ethnicity. These variations contribute to large differences in antenatal detection rates for SGA PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DYWxsZWM8L0F1dGhvcj48WWVhcj4yMDE1PC9ZZWFyPjxS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=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DYWxsZWM8L0F1dGhvcj48WWVhcj4yMDE1PC9ZZWFyPjxS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=
ADDIN EN.CITE.DATA 5, 7, 10, 11.The 10th centile has been studied most frequently, although lower centiles (3rd, 5th) have also been used in an attempt to grade the severity of SGA PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5SQ09HPC9BdXRob3I+PFllYXI+MjAxMzwvWWVhcj48UmVj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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5SQ09HPC9BdXRob3I+PFllYXI+MjAxMzwvWWVhcj48UmVj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ADDIN EN.CITE.DATA 12, 13. Hadlock et al. have suggested that the use of an EFW <10th centile may be superior to AC alone with good predictive capacity for the detection of SGA ADDIN EN.CITE <EndNote><Cite><Author>Chauhan</Author><Year>2006</Year><RecNum>13</RecNum><DisplayText><style face="superscript">14</style></DisplayText><record><rec-number>13</rec-number><foreign-keys><key app="EN" db-id="ee5sr0epbw0dzpevtw3vte2hswx0adtdv59v" timestamp="1468334876">13</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Chauhan, S. P.</author><author>Cole, J.</author><author>Sanderson, M.</author><author>Magann, E. F.</author><author>Scardo, J. A.</author></authors></contributors><auth-address>Aurora Health Care, West Allis, WI 53227, USA. suneet.chauhan@</auth-address><titles><title>Suspicion of intrauterine growth restriction: Use of abdominal circumference alone or estimated fetal weight below 10%</title><secondary-title>J Matern Fetal Neonatal Med</secondary-title></titles><periodical><full-title>J Matern Fetal Neonatal Med</full-title></periodical><pages>557-62</pages><volume>19</volume><number>9</number><edition>2006/09/13</edition><keywords><keyword>Abdomen/growth & development</keyword><keyword>Anthropometry/*methods</keyword><keyword>Female</keyword><keyword>Fetal Growth Retardation/*ultrasonography</keyword><keyword>*Fetal Weight</keyword><keyword>Gestational Age</keyword><keyword>Humans</keyword><keyword>Predictive Value of Tests</keyword><keyword>Pregnancy</keyword><keyword>Retrospective Studies</keyword><keyword>Risk</keyword></keywords><dates><year>2006</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>1476-7058 (Print)
1476-4954 (Linking)</isbn><accession-num>16966124</accession-num><urls><related-urls><url> [pii]
10.1080/14767050600798267</electronic-resource-num><language>eng</language></record></Cite></EndNote>14, although even greater prediction occurs when both the AC and EFW are <10th centile PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DaGF1aGFuPC9BdXRob3I+PFllYXI+MjAwNjwvWWVhcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DaGF1aGFuPC9BdXRob3I+PFllYXI+MjAwNjwvWWVhcj48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ADDIN EN.CITE.DATA 14, 15. It has recently been suggested that the change in velocity of growth across gestation may be a better predictor of APO than a single assessment ADDIN EN.CITE <EndNote><Cite><Author>Sovio</Author><Year>2015</Year><RecNum>15</RecNum><DisplayText><style face="superscript">16</style></DisplayText><record><rec-number>15</rec-number><foreign-keys><key app="EN" db-id="ee5sr0epbw0dzpevtw3vte2hswx0adtdv59v" timestamp="1468334876">15</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sovio, U.</author><author>White, I. R.</author><author>Dacey, A.</author><author>Pasupathy, D.</author><author>Smith, G. C.</author></authors></contributors><auth-address>Department of Obstetrics and Gynaecology, University of Cambridge, National Institute for Health Research Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK.
Medical Research Council Biostatistics Unit, Institute of Public Health, Cambridge, UK.
Division of Women's Health, Women's Health Academic Centre, King's Health Partners, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Department of Obstetrics and Gynaecology, University of Cambridge, National Institute for Health Research Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK. Electronic address: gcss2@cam.ac.uk.</auth-address><titles><title>Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study</title><secondary-title>Lancet</secondary-title></titles><periodical><full-title>Lancet</full-title></periodical><edition>2015/09/12</edition><dates><year>2015</year><pub-dates><date>Sep 7</date></pub-dates></dates><isbn>1474-547X (Electronic)
0140-6736 (Linking)</isbn><accession-num>26360240</accession-num><urls><related-urls><url>(15)00131-2 [pii]
10.1016/S0140-6736(15)00131-2</electronic-resource-num><language>Eng</language></record></Cite></EndNote>16. Increasingly, fetal growth clinics are being introduced in order to optimise the diagnosis and management of suspected SGA fetuses.The difficulty in accurate diagnosis and pregnancy planning is further exacerbated by the timing of the ultrasound assessment. Some fetuses may not be destined to continue to maintain the same growth velocity close to term. It may be these fetuses that are at greatest risk as they ‘cross’ centiles in late pregnancy, rather than being identified and remaining as SGA throughout gestation ADDIN EN.CITE <EndNote><Cite><Author>Sovio</Author><Year>2015</Year><RecNum>15</RecNum><DisplayText><style face="superscript">16</style></DisplayText><record><rec-number>15</rec-number><foreign-keys><key app="EN" db-id="ee5sr0epbw0dzpevtw3vte2hswx0adtdv59v" timestamp="1468334876">15</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sovio, U.</author><author>White, I. R.</author><author>Dacey, A.</author><author>Pasupathy, D.</author><author>Smith, G. C.</author></authors></contributors><auth-address>Department of Obstetrics and Gynaecology, University of Cambridge, National Institute for Health Research Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK.
Medical Research Council Biostatistics Unit, Institute of Public Health, Cambridge, UK.
Division of Women's Health, Women's Health Academic Centre, King's Health Partners, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Department of Obstetrics and Gynaecology, University of Cambridge, National Institute for Health Research Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK. Electronic address: gcss2@cam.ac.uk.</auth-address><titles><title>Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study</title><secondary-title>Lancet</secondary-title></titles><periodical><full-title>Lancet</full-title></periodical><edition>2015/09/12</edition><dates><year>2015</year><pub-dates><date>Sep 7</date></pub-dates></dates><isbn>1474-547X (Electronic)
0140-6736 (Linking)</isbn><accession-num>26360240</accession-num><urls><related-urls><url>(15)00131-2 [pii]
10.1016/S0140-6736(15)00131-2</electronic-resource-num><language>Eng</language></record></Cite></EndNote>16. Following the confirmation of SGA labour induction is usually offered to eliminate the perceived risk of late stillbirth ADDIN EN.CITE <EndNote><Cite><Author>RCOG</Author><Year>2013</Year><RecNum>13</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>13</rec-number><foreign-keys><key app="EN" db-id="e9f2za9x6x9ssqezxppp02wvefe2texvz22d">13</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>RCOG</author></authors></contributors><titles><title>The Investigation and Management of the Small-for-Gestational-Age Fetus</title><secondary-title>Royal College of Obstetricians and Gynaecologists</secondary-title></titles><periodical><full-title>Royal College of Obstetricians and Gynaecologists</full-title></periodical><pages>1-34</pages><volume>Green-top Guideline No.31</volume><dates><year>2013</year></dates><urls></urls></record></Cite></EndNote>12. Whilst the prevention of stillbirth is a laudable goal, the low sensitivity of the currently available screening tests and false positive labelling of SGA may lead to more interventions in pregnancy, which may increase maternal anxiety and has significant resource implications for maternity service providers. The management of fetal growth restriction with abnormal Dopplers is very well established and fetal biometry is not critical for clinical decision making. The significant proportion of fetuses diagnosed as SGA without Doppler abnormalities represent a much greater clinical dilemma. Changes in the approach to managing these pregnancies have led to an increase in the demands and medicalisation of these pregnancies and it is these pregnancies that create the largest burden to health care services as a whole. The difficulty in accurate assessment of growth restriction and any beneficial impact of screening programmes does not stop with birth. Whilst the birth weight of a baby is easily and routinely measured, the clinical relevance placed upon a birth weight centiles is determined by paediatric clinicians and a variety of postnatal/neonatal birth weight charts, which may be international, national, local or customised PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5QYXBhZ2VvcmdoaW91PC9BdXRob3I+PFllYXI+MjAxNDwv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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5QYXBhZ2VvcmdoaW91PC9BdXRob3I+PFllYXI+MjAxNDwv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ADDIN EN.CITE.DATA 17-19.There has been only a limited consideration of the impact of the variation in charts on the correlation between fetal biometry and birth weight PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Ob3JyaXM8L0F1dGhvcj48WWVhcj4yMDE1PC9ZZWFyPjxS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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Ob3JyaXM8L0F1dGhvcj48WWVhcj4yMDE1PC9ZZWFyPjxS
ZWNOdW0+MTk8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0Ij4y
MDwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjE5PC9yZWMtbnVtYmVy
Pjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0iZWU1c3IwZXBidzBkenBldnR3M3Z0
ZTJoc3d4MGFkdGR2NTl2IiB0aW1lc3RhbXA9IjE0NjgzMzQ4NzYiPjE5PC9rZXk+PC9mb3JlaWdu
LWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxjb250
cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5Ob3JyaXMsIFQuPC9hdXRob3I+PGF1dGhvcj5Kb2hu
c29uLCBXLjwvYXV0aG9yPjxhdXRob3I+RmFycmFyLCBELjwvYXV0aG9yPjxhdXRob3I+VHVmZm5l
bGwsIEQuPC9hdXRob3I+PGF1dGhvcj5XcmlnaHQsIEouPC9hdXRob3I+PGF1dGhvcj5DYW1lcm9u
LCBOLjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPkNlbnRy
ZSBmb3IgR2xvYmFsIEhlYWx0aCBhbmQgSHVtYW4gRGV2ZWxvcG1lbnQsIFNjaG9vbCBvZiBTcG9y
dCwgRXhlcmNpc2UgYW5kIEhlYWx0aCBTY2llbmNlcywgTG91Z2hib3JvdWdoIFVuaXZlcnNpdHks
IExvdWdoYm9yb3VnaCwgVUsuJiN4RDtNUkMgVW5pdCBmb3IgTGlmZWxvbmcgSGVhbHRoICZhbXA7
IEFnZWluZywgVW5pdmVyc2l0eSBDb2xsZWdlIExvbmRvbiwgTG9uZG9uLCBVSy4mI3hEO0JyYWRm
b3JkIEluc3RpdHV0ZSBmb3IgSGVhbHRoIFJlc2VhcmNoLCBCcmFkZm9yZCBSb3lhbCBJbmZpcm1h
cnksIEJyYWRmb3JkLCBVSy4mI3hEO0JyYWRmb3JkIFRlYWNoaW5nIEhvc3BpdGFscyBOSFMgRm91
bmRhdGlvbiBUcnVzdCwgQnJhZGZvcmQgUm95YWwgSW5maXJtYXJ5LCBCcmFkZm9yZCwgVUsuPC9h
dXRoLWFkZHJlc3M+PHRpdGxlcz48dGl0bGU+U21hbGwtZm9yLWdlc3RhdGlvbmFsIGFnZSBhbmQg
bGFyZ2UtZm9yLWdlc3RhdGlvbmFsIGFnZSB0aHJlc2hvbGRzIHRvIHByZWRpY3QgaW5mYW50cyBh
dCByaXNrIG9mIGFkdmVyc2UgZGVsaXZlcnkgYW5kIG5lb25hdGFsIG91dGNvbWVzOiBhcmUgY3Vy
cmVudCBjaGFydHMgYWRlcXVhdGU/IEFuIG9ic2VydmF0aW9uYWwgc3R1ZHkgZnJvbSB0aGUgQm9y
biBpbiBCcmFkZm9yZCBjb2hvcnQ8L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+Qk1KIE9wZW48L3Nl
Y29uZGFyeS10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5CTUogT3Blbjwv
ZnVsbC10aXRsZT48L3BlcmlvZGljYWw+PHBhZ2VzPmUwMDY3NDM8L3BhZ2VzPjx2b2x1bWU+NTwv
dm9sdW1lPjxudW1iZXI+MzwvbnVtYmVyPjxlZGl0aW9uPjIwMTUvMDMvMTk8L2VkaXRpb24+PGtl
eXdvcmRzPjxrZXl3b3JkPkFkdWx0PC9rZXl3b3JkPjxrZXl3b3JkPkFyZWEgVW5kZXIgQ3VydmU8
L2tleXdvcmQ+PGtleXdvcmQ+KkJpcnRoIFdlaWdodDwva2V5d29yZD48a2V5d29yZD5EZWxpdmVy
eSwgT2JzdGV0cmljLyphZHZlcnNlIGVmZmVjdHM8L2tleXdvcmQ+PGtleXdvcmQ+RHlzdG9jaWEv
ZXRobm9sb2d5L2V0aW9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPkZlbWFsZTwva2V5d29yZD48a2V5
d29yZD4qR2VzdGF0aW9uYWwgQWdlPC9rZXl3b3JkPjxrZXl3b3JkPkdyZWF0IEJyaXRhaW48L2tl
eXdvcmQ+PGtleXdvcmQ+SHVtYW5zPC9rZXl3b3JkPjxrZXl3b3JkPkluZmFudCwgTmV3Ym9ybjwv
a2V5d29yZD48a2V5d29yZD5JbmZhbnQsIFNtYWxsIGZvciBHZXN0YXRpb25hbCBBZ2U8L2tleXdv
cmQ+PGtleXdvcmQ+TWFsZTwva2V5d29yZD48a2V5d29yZD4qTWVkaWNhbCBSZWNvcmRzL3N0YW5k
YXJkczwva2V5d29yZD48a2V5d29yZD5PYnN0ZXRyaWMgTGFib3IgQ29tcGxpY2F0aW9ucy9ldGhu
b2xvZ3kvKmV0aW9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPlBha2lzdGFuL2V0aG5vbG9neTwva2V5
d29yZD48a2V5d29yZD5QcmVnbmFuY3k8L2tleXdvcmQ+PGtleXdvcmQ+UHJlZ25hbmN5IE91dGNv
bWUvKmV0aG5vbG9neTwva2V5d29yZD48a2V5d29yZD5Qcm9zcGVjdGl2ZSBTdHVkaWVzPC9rZXl3
b3JkPjxrZXl3b3JkPlJPQyBDdXJ2ZTwva2V5d29yZD48a2V5d29yZD5SaXNrIEZhY3RvcnM8L2tl
eXdvcmQ+PGtleXdvcmQ+WW91bmcgQWR1bHQ8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHll
YXI+MjAxNTwveWVhcj48L2RhdGVzPjxpc2JuPjIwNDQtNjA1NSAoRWxlY3Ryb25pYyk8L2lzYm4+
PGFjY2Vzc2lvbi1udW0+MjU3ODM0MjQ8L2FjY2Vzc2lvbi1udW0+PHVybHM+PHJlbGF0ZWQtdXJs
cz48dXJsPmh0dHA6Ly93d3cubmNiaS5ubG0ubmloLmdvdi9wdWJtZWQvMjU3ODM0MjQ8L3VybD48
L3JlbGF0ZWQtdXJscz48L3VybHM+PGN1c3RvbTI+NDM2ODkyODwvY3VzdG9tMj48ZWxlY3Ryb25p
Yy1yZXNvdXJjZS1udW0+MTAuMTEzNi9ibWpvcGVuLTIwMTQtMDA2NzQzJiN4RDtibWpvcGVuLTIw
MTQtMDA2NzQzIFtwaWldPC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48bGFuZ3VhZ2U+ZW5nPC9s
YW5ndWFnZT48L3JlY29yZD48L0NpdGU+PC9FbmROb3RlPgB=
ADDIN EN.CITE.DATA 20. We have, therefore, investigated the impact of different ultrasound assessment tools used in our high risk fetal growth clinic on the diagnostic accuracy of 3rd trimester ultrasound in predicting an SGA newborn. Our aim was to identify which antenatal assessment tools perform the best at detecting a birth weight <10th centile for gestational age when compared to a variety of postnatal charts. Ideally, one would expect a clinically useful test to achieve both sensitivity and specificity above 90%. METHODSWe identified all consecutive cases of suspected SGA referred, after primary screening with symphysial fundal height measurement and ultrasonographer assessment, to specialist fetal growth clinic between January and October 2014. The indication for referral in all cases was ultrasound evidence of EFW <10 centile on the Gestation Related Optimal Weight (GROW) chart. These initial scans were performed by sonographers or specialists midwifes as part of the local screening programme. A review in the specialist fetal growth clinic included a detailed assessment of fetal biometry, liquor and fetal Doppler. Further management depended upon the EFW using the Hadlock calculation ADDIN EN.CITE <EndNote><Cite><Author>Hadlock</Author><Year>1984</Year><RecNum>14</RecNum><DisplayText><style face="superscript">15</style></DisplayText><record><rec-number>14</rec-number><foreign-keys><key app="EN" db-id="ee5sr0epbw0dzpevtw3vte2hswx0adtdv59v" timestamp="1468334876">14</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hadlock, F. P.</author><author>Harrist, R. B.</author><author>Carpenter, R. J.</author><author>Deter, R. L.</author><author>Park, S. K.</author></authors></contributors><titles><title>Sonographic estimation of fetal weight. The value of femur length in addition to head and abdomen measurements</title><secondary-title>Radiology</secondary-title></titles><periodical><full-title>Radiology</full-title></periodical><pages>535-40</pages><volume>150</volume><number>2</number><edition>1984/02/01</edition><keywords><keyword>Abdomen/anatomy & histology</keyword><keyword>Anthropometry</keyword><keyword>*Body Weight</keyword><keyword>Cephalometry</keyword><keyword>Female</keyword><keyword>Fetus/*anatomy & histology</keyword><keyword>Humans</keyword><keyword>Pregnancy</keyword><keyword>*Ultrasonography</keyword></keywords><dates><year>1984</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>0033-8419 (Print)
0033-8419 (Linking)</isbn><accession-num>6691115</accession-num><urls><related-urls><url> which was plotted on a customised antenatal fetal weight chart (GROW) ADDIN EN.CITE <EndNote><Cite><Author>Gardosi</Author><Year>1995</Year><RecNum>17</RecNum><DisplayText><style face="superscript">18</style></DisplayText><record><rec-number>17</rec-number><foreign-keys><key app="EN" db-id="ee5sr0epbw0dzpevtw3vte2hswx0adtdv59v" timestamp="1468334876">17</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gardosi, J.</author><author>Mongelli, M.</author><author>Wilcox, M.</author><author>Chang, A.</author></authors></contributors><auth-address>Department of Obstetrics and Gynaecology, University Hospital, Queen's Medical Centre, Nottingham, UK.</auth-address><titles><title>An adjustable fetal weight standard</title><secondary-title>Ultrasound Obstet Gynecol</secondary-title></titles><periodical><full-title>Ultrasound Obstet Gynecol</full-title></periodical><pages>168-74</pages><volume>6</volume><number>3</number><edition>1995/09/01</edition><keywords><keyword>*Birth Weight</keyword><keyword>*Body Weight</keyword><keyword>*Embryonic and Fetal Development</keyword><keyword>Ethnic Groups</keyword><keyword>Female</keyword><keyword>Gestational Age</keyword><keyword>Humans</keyword><keyword>Infant, Newborn</keyword><keyword>Male</keyword><keyword>Predictive Value of Tests</keyword><keyword>Pregnancy</keyword><keyword>Reference Values</keyword><keyword>Regression Analysis</keyword><keyword>Reproducibility of Results</keyword><keyword>Sex Characteristics</keyword><keyword>Smoking/adverse effects</keyword><keyword>Software</keyword><keyword>*Ultrasonography, Prenatal</keyword></keywords><dates><year>1995</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>0960-7692 (Print)
0960-7692 (Linking)</isbn><accession-num>8521065</accession-num><urls><related-urls><url>. Fetuses confirmed as SGA (<10th centile) were managed in accordance with the RCOG green top guideline ADDIN EN.CITE <EndNote><Cite><Author>RCOG</Author><Year>2013</Year><RecNum>5</RecNum><DisplayText><style face="superscript">5</style></DisplayText><record><rec-number>5</rec-number><foreign-keys><key app="EN" db-id="ee5sr0epbw0dzpevtw3vte2hswx0adtdv59v" timestamp="1468334875">5</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>RCOG</author></authors></contributors><titles><title>The investigation and management of the small-for-gestational-age fetus</title><secondary-title>Green-top guideline No.31</secondary-title></titles><periodical><full-title>Green-top guideline No.31</full-title></periodical><dates><year>2013</year></dates><urls></urls></record></Cite></EndNote>5 with regular ultrasound (every 2-3 weeks), umbilical and middle cerebral artery (MCA) Dopplers. Delivery was indicated if there was clinical concern about fetal or maternal wellbeing, or alternatively induction of labour was offered after 37 weeks. Fetuses that were identified as having an EFW >10th centile (AGA) and were referred back to routine antenatal care, although their outcomes were still included in the analysis.For the purposes of this study, we have excluded all fetuses with abnormal Doppler, oligohydramnios or structural anomalies identified at any point in their care. This approach was taken as the purpose of the study was to identify variation in fetal growth assessment in a SGA population without critical IUGR. On completion of pregnancy, fetal biometry parameters were assessed from the last ultrasound scan prior to delivery. AC velocity was calculated from 2 scans between 18-22 and 34-38 weeks of gestation. 23 cases had to be excluded from AC velocity calculations due to missing data (n=7), or delivery prior to 34 weeks (n=16). All measurements were evaluated using the following parameters:Estimated fetal weightGROW is a customised growth chart using fetal biometry and maternal characteristics to create an individualised growth curve for that pregnancy ADDIN EN.CITE <EndNote><Cite><Author>Gardosi</Author><Year>1995</Year><RecNum>17</RecNum><DisplayText><style face="superscript">18</style></DisplayText><record><rec-number>17</rec-number><foreign-keys><key app="EN" db-id="ee5sr0epbw0dzpevtw3vte2hswx0adtdv59v" timestamp="1468334876">17</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gardosi, J.</author><author>Mongelli, M.</author><author>Wilcox, M.</author><author>Chang, A.</author></authors></contributors><auth-address>Department of Obstetrics and Gynaecology, University Hospital, Queen's Medical Centre, Nottingham, UK.</auth-address><titles><title>An adjustable fetal weight standard</title><secondary-title>Ultrasound Obstet Gynecol</secondary-title></titles><periodical><full-title>Ultrasound Obstet Gynecol</full-title></periodical><pages>168-74</pages><volume>6</volume><number>3</number><edition>1995/09/01</edition><keywords><keyword>*Birth Weight</keyword><keyword>*Body Weight</keyword><keyword>*Embryonic and Fetal Development</keyword><keyword>Ethnic Groups</keyword><keyword>Female</keyword><keyword>Gestational Age</keyword><keyword>Humans</keyword><keyword>Infant, Newborn</keyword><keyword>Male</keyword><keyword>Predictive Value of Tests</keyword><keyword>Pregnancy</keyword><keyword>Reference Values</keyword><keyword>Regression Analysis</keyword><keyword>Reproducibility of Results</keyword><keyword>Sex Characteristics</keyword><keyword>Smoking/adverse effects</keyword><keyword>Software</keyword><keyword>*Ultrasonography, Prenatal</keyword></keywords><dates><year>1995</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>0960-7692 (Print)
0960-7692 (Linking)</isbn><accession-num>8521065</accession-num><urls><related-urls><url> produced an estimated fetal weight chart in 1991 based upon biometric assessment ADDIN EN.CITE <EndNote><Cite><Author>Hadlock</Author><Year>1991</Year><RecNum>24</RecNum><DisplayText><style face="superscript">21</style></DisplayText><record><rec-number>24</rec-number><foreign-keys><key app="EN" db-id="ee5sr0epbw0dzpevtw3vte2hswx0adtdv59v" timestamp="1468335042">24</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hadlock, F. P.</author><author>Harrist, R. B.</author><author>Martinez-Poyer, J.</author></authors></contributors><titles><title>In utero analysis of fetal growth: a sonographic weight standard</title><secondary-title>Radiology</secondary-title></titles><periodical><full-title>Radiology</full-title></periodical><pages>129-33</pages><volume>181</volume><number>1</number><dates><year>1991</year></dates><urls></urls></record></Cite></EndNote>21.Mikolayczyk produced an international population with the express purpose of its being used in developing countries ADDIN EN.CITE <EndNote><Cite><Author>Mikolajczyk</Author><Year>2011</Year><RecNum>18</RecNum><DisplayText><style face="superscript">19</style></DisplayText><record><rec-number>18</rec-number><foreign-keys><key app="EN" db-id="ee5sr0epbw0dzpevtw3vte2hswx0adtdv59v" timestamp="1468334876">18</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mikolajczyk, R.T.</author><author>Zhang, J.</author><author>Betran, A.P.</author><author>Souza, J.P.</author><author>Gulmezoglu, A.M.</author><author>Merialdi, M.</author></authors></contributors><titles><title>A global reference for fetal-weight and birthweight percentiles</title><secondary-title>Lancet</secondary-title></titles><periodical><full-title>Lancet</full-title></periodical><pages>1855-61</pages><volume>377</volume><number>9780</number><dates><year>2011</year></dates><urls></urls></record></Cite></EndNote>19.Abdominal circumferenceHadlock is a population chart based upon AC measurement ADDIN EN.CITE <EndNote><Cite><Author>Hadlock</Author><Year>1984</Year><RecNum>20</RecNum><DisplayText><style face="superscript">22</style></DisplayText><record><rec-number>20</rec-number><foreign-keys><key app="EN" db-id="ee5sr0epbw0dzpevtw3vte2hswx0adtdv59v" timestamp="1468334876">20</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hadlock, F. P.</author><author>Deter, R. L.</author><author>Harrist, R. B.</author><author>Park, S. K.</author></authors></contributors><titles><title>Estimating fetal age: computer-assisted analysis of multiple fetal growth parameters</title><secondary-title>Radiology</secondary-title></titles><periodical><full-title>Radiology</full-title></periodical><pages>497-501</pages><volume>152</volume><number>2</number><edition>1984/08/01</edition><keywords><keyword>Abdomen/anatomy & histology</keyword><keyword>*Computers</keyword><keyword>Female</keyword><keyword>Femur/anatomy & histology</keyword><keyword>*Gestational Age</keyword><keyword>Head/anatomy & histology</keyword><keyword>Humans</keyword><keyword>Pregnancy</keyword><keyword>Regression Analysis</keyword><keyword>*Ultrasonography</keyword></keywords><dates><year>1984</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>0033-8419 (Print)
0033-8419 (Linking)</isbn><accession-num>6739822</accession-num><urls><related-urls><url> is a population chart based upon AC measurement ADDIN EN.CITE <EndNote><Cite><Author>Chitty</Author><Year>1994</Year><RecNum>21</RecNum><DisplayText><style face="superscript">23</style></DisplayText><record><rec-number>21</rec-number><foreign-keys><key app="EN" db-id="ee5sr0epbw0dzpevtw3vte2hswx0adtdv59v" timestamp="1468334876">21</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Chitty, L. S.</author><author>Altman, D. G.</author><author>Henderson, A.</author><author>Campbell, S.</author></authors></contributors><auth-address>Department of Clinical Genetics, Institute of Child Health, London, UK.</auth-address><titles><title>Charts of fetal size: 3. Abdominal measurements</title><secondary-title>Br J Obstet Gynaecol</secondary-title></titles><periodical><full-title>Br J Obstet Gynaecol</full-title></periodical><pages>125-31</pages><volume>101</volume><number>2</number><edition>1994/02/01</edition><keywords><keyword>Abdomen/*anatomy & histology</keyword><keyword>Cross-Sectional Studies</keyword><keyword>Female</keyword><keyword>Fetus/*anatomy & histology</keyword><keyword>Gestational Age</keyword><keyword>Humans</keyword><keyword>Pregnancy</keyword><keyword>Prospective Studies</keyword><keyword>Reference Values</keyword><keyword>Ultrasonography, Prenatal</keyword></keywords><dates><year>1994</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>0306-5456 (Print)
0306-5456 (Linking)</isbn><accession-num>8305386</accession-num><urls><related-urls><url> Intergrowth 21st project (Ig-21) is a multiethnic population chart developed to provide an international standard for fetal growth PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5QYXBhZ2VvcmdoaW91PC9BdXRob3I+PFllYXI+MjAxNDwv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=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5QYXBhZ2VvcmdoaW91PC9BdXRob3I+PFllYXI+MjAxNDwv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=
ADDIN EN.CITE.DATA 17. AC velocity has been calculated using a tool provided by the Pregnancy Outcome Prediction (POP) study ADDIN EN.CITE <EndNote><Cite><Author>Sovio</Author><Year>2015</Year><RecNum>15</RecNum><DisplayText><style face="superscript">16</style></DisplayText><record><rec-number>15</rec-number><foreign-keys><key app="EN" db-id="ee5sr0epbw0dzpevtw3vte2hswx0adtdv59v" timestamp="1468334876">15</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sovio, U.</author><author>White, I. R.</author><author>Dacey, A.</author><author>Pasupathy, D.</author><author>Smith, G. C.</author></authors></contributors><auth-address>Department of Obstetrics and Gynaecology, University of Cambridge, National Institute for Health Research Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK.
Medical Research Council Biostatistics Unit, Institute of Public Health, Cambridge, UK.
Division of Women's Health, Women's Health Academic Centre, King's Health Partners, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Department of Obstetrics and Gynaecology, University of Cambridge, National Institute for Health Research Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK. Electronic address: gcss2@cam.ac.uk.</auth-address><titles><title>Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study</title><secondary-title>Lancet</secondary-title></titles><periodical><full-title>Lancet</full-title></periodical><edition>2015/09/12</edition><dates><year>2015</year><pub-dates><date>Sep 7</date></pub-dates></dates><isbn>1474-547X (Electronic)
0140-6736 (Linking)</isbn><accession-num>26360240</accession-num><urls><related-urls><url>(15)00131-2 [pii]
10.1016/S0140-6736(15)00131-2</electronic-resource-num><language>Eng</language></record></Cite></EndNote>16.Birth weight chartsGROW is a postnatal growth chart which utilises fetal biometry and maternal characteristics to create an individualised growth curve for that pregnancy ADDIN EN.CITE <EndNote><Cite><Author>Gardosi</Author><Year>1995</Year><RecNum>17</RecNum><DisplayText><style face="superscript">18</style></DisplayText><record><rec-number>17</rec-number><foreign-keys><key app="EN" db-id="ee5sr0epbw0dzpevtw3vte2hswx0adtdv59v" timestamp="1468334876">17</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gardosi, J.</author><author>Mongelli, M.</author><author>Wilcox, M.</author><author>Chang, A.</author></authors></contributors><auth-address>Department of Obstetrics and Gynaecology, University Hospital, Queen's Medical Centre, Nottingham, UK.</auth-address><titles><title>An adjustable fetal weight standard</title><secondary-title>Ultrasound Obstet Gynecol</secondary-title></titles><periodical><full-title>Ultrasound Obstet Gynecol</full-title></periodical><pages>168-74</pages><volume>6</volume><number>3</number><edition>1995/09/01</edition><keywords><keyword>*Birth Weight</keyword><keyword>*Body Weight</keyword><keyword>*Embryonic and Fetal Development</keyword><keyword>Ethnic Groups</keyword><keyword>Female</keyword><keyword>Gestational Age</keyword><keyword>Humans</keyword><keyword>Infant, Newborn</keyword><keyword>Male</keyword><keyword>Predictive Value of Tests</keyword><keyword>Pregnancy</keyword><keyword>Reference Values</keyword><keyword>Regression Analysis</keyword><keyword>Reproducibility of Results</keyword><keyword>Sex Characteristics</keyword><keyword>Smoking/adverse effects</keyword><keyword>Software</keyword><keyword>*Ultrasonography, Prenatal</keyword></keywords><dates><year>1995</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>0960-7692 (Print)
0960-7692 (Linking)</isbn><accession-num>8521065</accession-num><urls><related-urls><url> intergrowth 21st project (Ig-21) is a multiethnic population chart developed to provide an international standard for neonatal growth PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5WaWxsYXI8L0F1dGhvcj48WWVhcj4yMDE0PC9ZZWFyPjxS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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5WaWxsYXI8L0F1dGhvcj48WWVhcj4yMDE0PC9ZZWFyPjxS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ADDIN EN.CITE.DATA 24.The WHO neonatal and infant growth chart is a UK population based birthweight chart PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Db2xlPC9BdXRob3I+PFllYXI+MTk5ODwvWWVhcj48UmVj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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Db2xlPC9BdXRob3I+PFllYXI+MTk5ODwvWWVhcj48UmVj
TnVtPjIzPC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNjcmlwdCI+MjU8
L3N0eWxlPjwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4yMzwvcmVjLW51bWJlcj48
Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9ImVlNXNyMGVwYncwZHpwZXZ0dzN2dGUy
aHN3eDBhZHRkdjU5diIgdGltZXN0YW1wPSIxNDY4MzM0ODc2Ij4yMzwva2V5PjwvZm9yZWlnbi1r
ZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlwZT48Y29udHJp
YnV0b3JzPjxhdXRob3JzPjxhdXRob3I+Q29sZSwgVC4gSi48L2F1dGhvcj48YXV0aG9yPkZyZWVt
YW4sIEouIFYuPC9hdXRob3I+PGF1dGhvcj5QcmVlY2UsIE0uIEEuPC9hdXRob3I+PC9hdXRob3Jz
PjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+TVJDIER1bm4gTnV0cml0aW9uIENlbnRyZSwg
Q2FtYnJpZGdlLCBVSy4gVGltLkNvbGVAbXJjLWR1bm4uY2FtLmFjLnVrPC9hdXRoLWFkZHJlc3M+
PHRpdGxlcz48dGl0bGU+QnJpdGlzaCAxOTkwIGdyb3d0aCByZWZlcmVuY2UgY2VudGlsZXMgZm9y
IHdlaWdodCwgaGVpZ2h0LCBib2R5IG1hc3MgaW5kZXggYW5kIGhlYWQgY2lyY3VtZmVyZW5jZSBm
aXR0ZWQgYnkgbWF4aW11bSBwZW5hbGl6ZWQgbGlrZWxpaG9vZDwvdGl0bGU+PHNlY29uZGFyeS10
aXRsZT5TdGF0IE1lZDwvc2Vjb25kYXJ5LXRpdGxlPjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxs
LXRpdGxlPlN0YXQgTWVkPC9mdWxsLXRpdGxlPjwvcGVyaW9kaWNhbD48cGFnZXM+NDA3LTI5PC9w
YWdlcz48dm9sdW1lPjE3PC92b2x1bWU+PG51bWJlcj40PC9udW1iZXI+PGVkaXRpb24+MTk5OC8w
My8xMzwvZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+QWRvbGVzY2VudDwva2V5d29yZD48a2V5
d29yZD5BZHVsdDwva2V5d29yZD48a2V5d29yZD4qQW50aHJvcG9tZXRyeTwva2V5d29yZD48a2V5
d29yZD5Cb2R5IEhlaWdodDwva2V5d29yZD48a2V5d29yZD5Cb2R5IE1hc3MgSW5kZXg8L2tleXdv
cmQ+PGtleXdvcmQ+Qm9keSBXZWlnaHQ8L2tleXdvcmQ+PGtleXdvcmQ+Q2VwaGFsb21ldHJ5PC9r
ZXl3b3JkPjxrZXl3b3JkPkNoaWxkPC9rZXl3b3JkPjxrZXl3b3JkPkNoaWxkLCBQcmVzY2hvb2w8
L2tleXdvcmQ+PGtleXdvcmQ+Q29uZmlkZW5jZSBJbnRlcnZhbHM8L2tleXdvcmQ+PGtleXdvcmQ+
RmVtYWxlPC9rZXl3b3JkPjxrZXl3b3JkPkdlc3RhdGlvbmFsIEFnZTwva2V5d29yZD48a2V5d29y
ZD5HcmVhdCBCcml0YWluPC9rZXl3b3JkPjxrZXl3b3JkPkhlYWQvZ3Jvd3RoICZhbXA7IGRldmVs
b3BtZW50PC9rZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48a2V5d29yZD5JbmZhbnQ8
L2tleXdvcmQ+PGtleXdvcmQ+Kkxpa2VsaWhvb2QgRnVuY3Rpb25zPC9rZXl3b3JkPjxrZXl3b3Jk
Pk1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+Kk1vZGVscywgU3RhdGlzdGljYWw8L2tleXdvcmQ+PGtl
eXdvcmQ+Tm9ybWFsIERpc3RyaWJ1dGlvbjwva2V5d29yZD48a2V5d29yZD5SZWZlcmVuY2UgVmFs
dWVzPC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5ZWFyPjE5OTg8L3llYXI+PHB1Yi1kYXRl
cz48ZGF0ZT5GZWIgMjg8L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNibj4wMjc3LTY3MTUg
KFByaW50KSYjeEQ7MDI3Ny02NzE1IChMaW5raW5nKTwvaXNibj48YWNjZXNzaW9uLW51bT45NDk2
NzIwPC9hY2Nlc3Npb24tbnVtPjx1cmxzPjxyZWxhdGVkLXVybHM+PHVybD5odHRwOi8vd3d3Lm5j
YmkubmxtLm5paC5nb3YvcHVibWVkLzk0OTY3MjA8L3VybD48L3JlbGF0ZWQtdXJscz48L3VybHM+
PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjEwMDIvKFNJQ0kpMTA5Ny0wMjU4KDE5OTgwMjI4
KTE3OjQmbHQ7NDA3OjpBSUQtU0lNNzQyJmd0OzMuMC5DTzsyLUwgW3BpaV08L2VsZWN0cm9uaWMt
cmVzb3VyY2UtbnVtPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0Vu
ZE5vdGU+
ADDIN EN.CITE.DATA 25. For this chart we have used the 9th centile as there is no 10th centile on postnatal charts.Mikolayczyk produced an international population with the express purpose of being used in developing countries ADDIN EN.CITE <EndNote><Cite><Author>Mikolajczyk</Author><Year>2011</Year><RecNum>18</RecNum><DisplayText><style face="superscript">19</style></DisplayText><record><rec-number>18</rec-number><foreign-keys><key app="EN" db-id="ee5sr0epbw0dzpevtw3vte2hswx0adtdv59v" timestamp="1468334876">18</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mikolajczyk, R.T.</author><author>Zhang, J.</author><author>Betran, A.P.</author><author>Souza, J.P.</author><author>Gulmezoglu, A.M.</author><author>Merialdi, M.</author></authors></contributors><titles><title>A global reference for fetal-weight and birthweight percentiles</title><secondary-title>Lancet</secondary-title></titles><periodical><full-title>Lancet</full-title></periodical><pages>1855-61</pages><volume>377</volume><number>9780</number><dates><year>2011</year></dates><urls></urls></record></Cite></EndNote>19.Diagnostic accuracyThe main outcome of interest was birthweight <10th centile for gestational age. Data for analysis were collected in terms of the number of true positives, true negatives, false positives and false negatives for each prenatal and antenatal assessment tool. Analyses are presented in terms of sensitivity, specificity, positive likelihood ratio and negative likelihood ratio for each prenatal assessment tool in relation to each postnatal birthweight assessment tool.In order to calculate diagnostic accuracy for each of the 5 antenatal assessment tools we have used following definitions:True positiveEFW/AC <10th centile by ultrasound at the last scan before delivery that triggered iatrogenic delivery (induction of labour or elective CS) with a birth weight <10th centileTrue negativeEFW/AC >10th centile by ultrasound at the last scan before delivery and did not undergo iatrogenic delivery for suspected IUGR/SGA followed by birth weight >10th centileFalse positiveEFW/AC<10thcentile by ultrasound at the last scan before delivery that triggered an iatrogenic delivery (induction of labour or elective CS) followed by birth weight >10th centileFalse negativeEFW/AC > 10th centile by ultrasound at the last scan before delivery and did not undergo iatrogenic delivery for suspected IUGR/SGA followed by birth weight <10 centileWe also assessed the ability of each antenatal test to predict those babies which would go on to have an APO. We have used a composite of adverse perinatal outcome as defined by the POP study ADDIN EN.CITE <EndNote><Cite><Author>Sovio</Author><Year>2015</Year><RecNum>15</RecNum><DisplayText><style face="superscript">16</style></DisplayText><record><rec-number>15</rec-number><foreign-keys><key app="EN" db-id="ee5sr0epbw0dzpevtw3vte2hswx0adtdv59v" timestamp="1468334876">15</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sovio, U.</author><author>White, I. R.</author><author>Dacey, A.</author><author>Pasupathy, D.</author><author>Smith, G. C.</author></authors></contributors><auth-address>Department of Obstetrics and Gynaecology, University of Cambridge, National Institute for Health Research Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK.
Medical Research Council Biostatistics Unit, Institute of Public Health, Cambridge, UK.
Division of Women's Health, Women's Health Academic Centre, King's Health Partners, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Department of Obstetrics and Gynaecology, University of Cambridge, National Institute for Health Research Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK. Electronic address: gcss2@cam.ac.uk.</auth-address><titles><title>Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study</title><secondary-title>Lancet</secondary-title></titles><periodical><full-title>Lancet</full-title></periodical><edition>2015/09/12</edition><dates><year>2015</year><pub-dates><date>Sep 7</date></pub-dates></dates><isbn>1474-547X (Electronic)
0140-6736 (Linking)</isbn><accession-num>26360240</accession-num><urls><related-urls><url>(15)00131-2 [pii]
10.1016/S0140-6736(15)00131-2</electronic-resource-num><language>Eng</language></record></Cite></EndNote>16 i.e. 5 min Apgar score of less than 7 OR metabolic acidosis (cord blood pH <7.1 and base deficit >10 mmol/L) OR term admission to the neonatal unit (admission <48 h after birth at ≥37 weeks’ gestational age and discharge ≥48 h after admission) OR stillbirth OR term livebirth associated with neonatal death OR hypoxic ischaemic encephalopathy OR use of inotropes OR need for mechanical ventilation OR severe metabolic acidosis (cord blood pH ≤7.0 and base deficit >12 mmol/L).Given the strong correlations between post-natal measurements, further assessment of antenatal assessments are modelled using a hierarchical summary receiver operator characteristics (HSROC) approach ADDIN EN.CITE <EndNote><Cite><Author>Rutter</Author><Year>2001</Year><RecNum>25</RecNum><DisplayText><style face="superscript">26</style></DisplayText><record><rec-number>25</rec-number><foreign-keys><key app="EN" db-id="ee5sr0epbw0dzpevtw3vte2hswx0adtdv59v" timestamp="1468335153">25</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rutter, C.M.</author><author>Gatsonis, C.A.</author></authors></contributors><titles><title>A hierarchical regression approach to meta-analysis of diagnostic test accuracy evaluations</title><secondary-title>Stat Med</secondary-title></titles><periodical><full-title>Stat Med</full-title></periodical><pages>2865-84</pages><volume>20</volume><number>19</number><dates><year>2001</year></dates><urls></urls></record></Cite></EndNote>26. This approach calculates the position and shapes of the receiver operator curve for each antenatal test. Posterior summaries of the fitted model allow for average estimates of antenatal test performance with results presented in terms of the negative likelihood ratio and positive likelihood ratio. Results are presented in terms of posterior medians with associated 95% credibility intervals.RESULTS118 women were referred as SGA during the study period. 77 found to be SGA on initial assessment and 41 were AGA. 13 fetuses had abnormal Doppler assessments at least once in their pregnancy and were excluded; leaving 105 women for analysis. Demographic and pregnancy outcome data can be found in Table One.Actual Birthweight was plotted against a variety of commonly used postnatal charts. GROW defined 62 babies as having a birth weight <10th centile (59%), 57 babies using Mikolayczyk (54%), 55 babies using Ig-21 (52%) and 51 babies using WHO (48.6%). Estimated fetal weight for prediction of birthweight <10th centileThe use of EFW plotted on antenatal GROW charts demonstrated a positive likelihood ratio of 1.9-3.0, negative likelihood ratio of 0.5-0.7, sensitivity of 53-56% and specificity of 72-81% (Table Two). The greatest sensitivity was 56% against postnatal GROW. The greatest specificity was against postnatal GROW.EFW plotted on antenatal Mikolayczyk charts demonstrated a positive likelihood ratio of 4.2-5.1, negative likelihood ratio of 0.4-0.5, sensitivity of 60-67% and specificity of 80-86%. (Table Two) The greatest sensitivity was 67% against postnatal WHO chart. The greatest specificity was against postnatal IG-21.Abdominal Circumference for prediction of birthweight <10th centileThe use of AC plotted on antenatal Hadlock charts demonstrated a positive likelihood ratio of 2.5-2.6, negative likelihood ratio of 0.3-0.4, sensitivity of 74-82% and specificity of 69-98% (Table Two). The greatest sensitivity was 82% against postnatal WHO chart. The greatest specificity was 98% against postnatal IG-21.The use of AC plotted on antenatal Chitty charts demonstrated a positive likelihood ratio of 4.7-6.1, negative likelihood ratio of 0.5-0.6, sensitivity of 44-51% and specificity of 90-92%. The greatest sensitivity was 51% against postnatal WHO chart. The greatest specificity was 92% against postnatal IG-21 chart.The use of AC plotted on antenatal IG-21 charts demonstrated a positive likelihood ratio of 5.9-10.9, negative likelihood ratio of 0.6-0.7, sensitivity of 35-41% and specificity of 94-96% (Table Two). The greatest sensitivity was 41% against postnatal WHO chart. The greatest specificity was 96% against postnatal WHO chart.Abdominal circumference velocity for prediction of birthweight <10th centileAssessment of antenatal AC velocity for the detection of a birthweight <10th centile demonstrated a positive likelihood ratio of 2.5-6.9, negative likelihood ratio of 0.8-0.9, sensitivity of 21-23% and specificity of 91-96% (Table Three). The greatest sensitivity was 23% against postnatal GROW, WHO and IG-21 charts. The greatest specificity was 96% against postnatal GROW.We have also calculated the diagnostic accuracy of AC and EFW combinations and found that all point estimates of sensitivity and specificity either worsened or remained unchanged (data not shown).Antenatal prediction of adverse perinatal outcomesOverall the median gestation at delivery for women in the cohort was 37 (28+4 – 41+2). 34 (32%) women had a caesarean delivery. There were 2 (1.9%) stillbirths within the study cohort, both of which were SGA with normal Doppler, one of which suffered a placental abruption and the other acute fetal thrombotic vasculopathy. There were 23 (24%) babies affected by an APO (Table Three). Antenatal detection (sensitivity) ranged from 22% to 57%, the specificity from 46%-88%, with a positive likelihood ratio of 0.7-2.2 and negative likelihood ratio of 0.8-1.2. The most sensitive antenatal test for prediction of APO was AC Hadlock (57%), whilst the most specific was AC velocity (88%). In addition, we calculated the diagnostic accuracy of AC growth velocity combined with EFW GROW <10th centile as suggested by Sovio et al (15) – sensitivity was 61% and specificity 56%.DISCUSSIONMain findings:We have demonstrated that the choice of both antenatal and postnatal tools to define SGA has critical impact on the detection rates of SGA babies. The sensitivity of different charts for the antenatal detection of SGA varied considerably depending upon the methods used, with sensitivities ranging from 21% to 82% and specificities from 69 to 98%. Overall, AC IG-21 had the best LR+ (5.9-10.9), LR- (0.6-0.7) and specificity (94%-96%). However, AC (Hadlock) had the best sensitivity for detecting antenatal SGA, ranging from 74% to 82%. None of the tests achieved both sensitivity and specificity above 90% (Figure One). Several charts (AC IG-21, Chitty AC, AC velocity, Mikolayczyk EFW and Hadlock EFW) demonstrated a positive LR of 5 but no one chart was paramount. Given that in the UK, birth weight is most commonly calculated either by WHO or GROW charts, our data suggest that there is no single antenatal tool with adequate diagnostic accuracy for SGA detection. Whilst antenatal assessment using AC IG-21 has the best overall performance, it has unacceptably low sensitivity (35%-41%). Sensitivity is highest with AC (Hadlock) (74%-82%) but with unacceptably low specificity for low birth weight by WHO (69%) and GROW (70%). AC growth velocity does not appear to improve diagnostic accuracy for low birth weight in our selected cohort of high risk women. None of the antenatal tests used were effective at predicting those pregnancies at risk of APO, with sensitivities ranging from 22 to 57% and specificities from 46 to 88%, best LR+ (0.7-2.2) and best LR- (0.8-1.2). However, when AC growth velocity was combined with EFW<10th centile as suggested by Sovio et al. ADDIN EN.CITE <EndNote><Cite><Author>Sovio</Author><Year>2015</Year><RecNum>15</RecNum><DisplayText><style face="superscript">16</style></DisplayText><record><rec-number>15</rec-number><foreign-keys><key app="EN" db-id="ee5sr0epbw0dzpevtw3vte2hswx0adtdv59v" timestamp="1468334876">15</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sovio, U.</author><author>White, I. R.</author><author>Dacey, A.</author><author>Pasupathy, D.</author><author>Smith, G. C.</author></authors></contributors><auth-address>Department of Obstetrics and Gynaecology, University of Cambridge, National Institute for Health Research Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK.
Medical Research Council Biostatistics Unit, Institute of Public Health, Cambridge, UK.
Division of Women's Health, Women's Health Academic Centre, King's Health Partners, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Department of Obstetrics and Gynaecology, University of Cambridge, National Institute for Health Research Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK. Electronic address: gcss2@cam.ac.uk.</auth-address><titles><title>Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study</title><secondary-title>Lancet</secondary-title></titles><periodical><full-title>Lancet</full-title></periodical><edition>2015/09/12</edition><dates><year>2015</year><pub-dates><date>Sep 7</date></pub-dates></dates><isbn>1474-547X (Electronic)
0140-6736 (Linking)</isbn><accession-num>26360240</accession-num><urls><related-urls><url>(15)00131-2 [pii]
10.1016/S0140-6736(15)00131-2</electronic-resource-num><language>Eng</language></record></Cite></EndNote>16 the sensitivity and specificity was increased, but still remains relatively poor at 61% and 56% respectively.Strength and limitations:It is important to stress that our study did not evaluate diagnostic accuracy of a universal SGA screening programme. Our focus was on the diagnostic accuracy of antenatal fetal biometry tests as applied to a high risk population. Our cohort was already screened using standard techniques (symphysial fundal height and ultrasonographer scan) and then reviewed and managed in a specialist fetal growth clinic. We excluded fetuses with IUGR and abnormal Dopplers as there are several nationally endorsed management pathways for these pregnancies. We also excluded those fetuses who were >10th centile on ultrasonographer assessment and therefore were never referred to the specialist growth clinic. By focussing on SGA fetuses without critical deterioration in fetal Doppler, unlike some other similar size studiesPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYXJjb25pPC9BdXRob3I+PFllYXI+MjAwODwvWWVhcj48
UmVjTnVtPjE8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0Ij4x
PC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MTwvcmVjLW51bWJlcj48
Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9ImVlNXNyMGVwYncwZHpwZXZ0dzN2dGUy
aHN3eDBhZHRkdjU5diIgdGltZXN0YW1wPSIxNDY4MzM0ODc1Ij4xPC9rZXk+PC9mb3JlaWduLWtl
eXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxjb250cmli
dXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5NYXJjb25pLCBBLiBNLjwvYXV0aG9yPjxhdXRob3I+Um9u
em9uaSwgUy48L2F1dGhvcj48YXV0aG9yPkJvenpldHRpLCBQLjwvYXV0aG9yPjxhdXRob3I+VmFp
bGF0aSwgUy48L2F1dGhvcj48YXV0aG9yPk1vcmFiaXRvLCBBLjwvYXV0aG9yPjxhdXRob3I+QmF0
dGFnbGlhLCBGLiBDLjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRy
ZXNzPkRlcGFydG1lbnQgb2YgT2JzdGV0cmljcyBhbmQgR3luZWNvbG9neSBhbmQgU3RhdGlzdGlj
cywgRE1TRCBTYW4gUGFvbG8sIFVuaXZlcnNpdHkgb2YgTWlsYW4sIE1pbGFuLCBJdGFseS4gYW5u
YW1hcmlhLm1hcmNvbmlAdW5pbWkuaXQ8L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5Db21w
YXJpc29uIG9mIGZldGFsIGFuZCBuZW9uYXRhbCBncm93dGggY3VydmVzIGluIGRldGVjdGluZyBn
cm93dGggcmVzdHJpY3Rpb248L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+T2JzdGV0IEd5bmVjb2w8
L3NlY29uZGFyeS10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5PYnN0ZXQg
R3luZWNvbDwvZnVsbC10aXRsZT48L3BlcmlvZGljYWw+PHBhZ2VzPjEyMjctMzQ8L3BhZ2VzPjx2
b2x1bWU+MTEyPC92b2x1bWU+PG51bWJlcj42PC9udW1iZXI+PGVkaXRpb24+MjAwOC8xMS8yODwv
ZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+Qmxvb2QgRmxvdyBWZWxvY2l0eS9waHlzaW9sb2d5
PC9rZXl3b3JkPjxrZXl3b3JkPkNhc2UtQ29udHJvbCBTdHVkaWVzPC9rZXl3b3JkPjxrZXl3b3Jk
PipDaGlsZCBEZXZlbG9wbWVudDwva2V5d29yZD48a2V5d29yZD5GZW1hbGU8L2tleXdvcmQ+PGtl
eXdvcmQ+RmV0YWwgRGV2ZWxvcG1lbnQvKnBoeXNpb2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+RmV0
YWwgR3Jvd3RoIFJldGFyZGF0aW9uLypkaWFnbm9zaXMvKnBoeXNpb3BhdGhvbG9neTwva2V5d29y
ZD48a2V5d29yZD5Gb2xsb3ctVXAgU3R1ZGllczwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tl
eXdvcmQ+PGtleXdvcmQ+SW5mYW50LCBOZXdib3JuPC9rZXl3b3JkPjxrZXl3b3JkPkluZmFudCwg
U21hbGwgZm9yIEdlc3RhdGlvbmFsIEFnZS8qZ3Jvd3RoICZhbXA7IGRldmVsb3BtZW50PC9rZXl3
b3JkPjxrZXl3b3JkPlByZWduYW5jeTwva2V5d29yZD48a2V5d29yZD5SZWZlcmVuY2UgVmFsdWVz
PC9rZXl3b3JkPjxrZXl3b3JkPlVtYmlsaWNhbCBBcnRlcmllcy9waHlzaW9wYXRob2xvZ3k8L2tl
eXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAwODwveWVhcj48cHViLWRhdGVzPjxkYXRl
PkRlYzwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjAwMjktNzg0NCAoUHJpbnQpJiN4
RDswMDI5LTc4NDQgKExpbmtpbmcpPC9pc2JuPjxhY2Nlc3Npb24tbnVtPjE5MDM3MDMwPC9hY2Nl
c3Npb24tbnVtPjx1cmxzPjxyZWxhdGVkLXVybHM+PHVybD5odHRwOi8vd3d3Lm5jYmkubmxtLm5p
aC5nb3YvcHVibWVkLzE5MDM3MDMwPC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxzPjxjdXN0b20y
PjI3NTI3MzA8L2N1c3RvbTI+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjEwOTcvQU9HLjBi
MDEzZTMxODE4YmRjN2UmI3hEOzExMi82LzEyMjcgW3BpaV08L2VsZWN0cm9uaWMtcmVzb3VyY2Ut
bnVtPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+AG==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYXJjb25pPC9BdXRob3I+PFllYXI+MjAwODwvWWVhcj48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==
ADDIN EN.CITE.DATA 1, we aimed to address the diagnostic accuracy for the majority of SGA pregnancies for which there is clinical uncertainty in management. We have tested all commonly used antenatal assessment charts and added the recently proposed AC velocity curve ADDIN EN.CITE <EndNote><Cite><Author>Sovio</Author><Year>2015</Year><RecNum>15</RecNum><DisplayText><style face="superscript">16</style></DisplayText><record><rec-number>15</rec-number><foreign-keys><key app="EN" db-id="ee5sr0epbw0dzpevtw3vte2hswx0adtdv59v" timestamp="1468334876">15</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sovio, U.</author><author>White, I. R.</author><author>Dacey, A.</author><author>Pasupathy, D.</author><author>Smith, G. C.</author></authors></contributors><auth-address>Department of Obstetrics and Gynaecology, University of Cambridge, National Institute for Health Research Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK.
Medical Research Council Biostatistics Unit, Institute of Public Health, Cambridge, UK.
Division of Women's Health, Women's Health Academic Centre, King's Health Partners, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Department of Obstetrics and Gynaecology, University of Cambridge, National Institute for Health Research Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK. Electronic address: gcss2@cam.ac.uk.</auth-address><titles><title>Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study</title><secondary-title>Lancet</secondary-title></titles><periodical><full-title>Lancet</full-title></periodical><edition>2015/09/12</edition><dates><year>2015</year><pub-dates><date>Sep 7</date></pub-dates></dates><isbn>1474-547X (Electronic)
0140-6736 (Linking)</isbn><accession-num>26360240</accession-num><urls><related-urls><url>(15)00131-2 [pii]
10.1016/S0140-6736(15)00131-2</electronic-resource-num><language>Eng</language></record></Cite></EndNote>16. We have taken the same approach with postnatal charts to highlight the differences that exist in current practice. This is particularly relevant when we consider that many manuscripts on fetal growth do not report exactly which postnatal charts were used, with the implication being that there is no difference PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Tb3ZpbzwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+PFJl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==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Tb3ZpbzwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+PFJl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==
ADDIN EN.CITE.DATA 10, 16. It should also be remembered that the initial screening for SGA was performed by ultrasonographers using GROW EFW charts. This pre-selection may have favoured subsequent performance of GROW EFW when repeated in our specialist clinic. We acknowledge that our study is of a relatively small size and limited to high risk UK pregnancies. Therefore extrapolating our findings to other clinical setting and particularly low risk populations should be undertaken with caution. It is worth noting that a study with twice as many SGA cases would have only minimal impact on the precision of the estimates. For example, assuming that the results remain the same, doubling our sample size would result in a change of 95% CI for AC (Hadlock) sensitivity to detect low birthweight (WHO) from 0.69-0.92 to 0.74-0.89. Interpretation:Clinicians attempting to identify and manage SGA, with the ultimate goal of reducing stillbirth, must strive to find a balance between highly sensitive tests that accurately detect most SGA fetuses, versus very specific tests that incorrectly label only very few AGA fetuses as SGA. Tests with low sensitivity could lead to more stillbirths and poor perinatal outcome, whilst a low specificity inevitably leads to more interventions, anxiety and medicalisation of pregnancy without necessarily improving perinatal outcomes. The interpretation of this data relies very much on the ‘value’ placed on over diagnosis of normal fetuses as SGA versus the potential risk of harm from ‘missing’ an SGA fetus.CONCLUSIONWe have demonstrated that a range of currently used antenatal biometry parameters, when used in selected cases of suspected SGA and managed by senior medical teams experienced in ultrasound, have inadequate test accuracy leading to low detection rates that may lead to unnecessary interventions and no impact on APO. We suggest that clinically important improvements in diagnostic accuracy will not come from further refinement of fetal biometry data generated by routine growth scans, but from a combination of fetal biometry and placental biomarkers.Acknowledgements We are grateful to Prof Gordon Smith who kindly gave us access to an unpublished AC velocity calculator and provided helpful comments on the manuscript.Disclosure of interests None of the authors has any interests to disclose.Contributions to authorshipAS, UA and ZA conceived the idea for the manuscript. BP and AS performed the data analysis. RJ performed the statistical analysis. BP, AS and ZA wrote the manuscript. Details of ethics approvalEthical approval was not sought as this formed part of an ongoing audit into the outcomes from the specialist fetal growth clinic.FundingNo funding was received for this study.REFERENCES ADDIN EN.REFLIST 1.Marconi AM, Ronzoni S, Bozzetti P, Vailati S, Morabito A, Battaglia FC. Comparison of fetal and neonatal growth curves in detecting growth restriction. Obstet Gynecol. 2008 Dec;112(6):1227-34.2.Gardosi J, Kady SM, McGeown P, Francis A, Tonks A. Classification of stillbirth by relevant condition at death (ReCoDe): population based cohort study. BMJ. 2005 Nov 12;331(7525):1113-7.3.Flenady V, Koopmans L, Middleton P, Froen JF, Smith GC, Gibbons K, et al. Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis. Lancet. 2011 Apr 16;377(9774):1331-40.4.NICE. Antenatal care: Routine care for the healthy pregnant woman. London: National Institute of Health and Clinical Excellence; 2008.5.RCOG. The investigation and management of the small-for-gestational-age fetus. Green-top guideline No31. 2013.6.Neilson JP. Symphysis-fundal height measurement in pregnancy. Cochrane Database Syst Rev. 2000(2):CD000944.7.Roma E, Arnau A, Berdala R, Bergos C, Montesinos J, Figueras F. Ultrasound screening for fetal growth restriction at 36 vs 32 weeks' gestation: a randomized trial (ROUTE). Ultrasound Obstet Gynecol. 2015 Oct;46(4):391-7.8.NICE. Antenatal care routine care for the healthy pregnant woman (CG62). National Institute for Clinical Excellence. London: NICE; 2008.9.Triunfo S, Parra-Saavedra M, Rodriguez-Sureda V, Crovetto F, Dominguez C, Gratacos E, et al. Angiogenic Factors and Doppler Evaluation in Normally Growing Fetuses at Routine Third-Trimester Scan: Prediction of Subsequent Low Birth Weight. Fetal Diagn Ther. 2015 Oct 1.10.Callec R, Lamy C, Perdriolle-Galet E, Patte C, Heude B, Morel O. Impact on obstetric outcome of third-trimester screening for small-for-gestational-age fetuses. Ultrasound Obstet Gynecol. 2015 Aug;46(2):216-20.11.Chauhan SP, Beydoun H, Chang E, Sandlin AT, Dahlke JD, Igwe E, et al. Prenatal detection of fetal growth restriction in newborns classified as small for gestational age: correlates and risk of neonatal morbidity. Am J Perinatol. 2014 Mar;31(3):187-94.12.RCOG. The Investigation and Management of the Small-for-Gestational-Age Fetus. Royal College of Obstetricians and Gynaecologists. 2013;Green-top Guideline No.31:1-34.13.Unterscheider J, Daly S, Geary MP, Kennelly MM, McAuliffe FM, O'Donoghue K, et al. Optimizing the definition of intrauterine growth restriction: the multicenter prospective PORTO Study. Am J Obstet Gynecol. 2013 Apr;208(4):290 e1-6.14.Chauhan SP, Cole J, Sanderson M, Magann EF, Scardo JA. Suspicion of intrauterine growth restriction: Use of abdominal circumference alone or estimated fetal weight below 10%. J Matern Fetal Neonatal Med. 2006 Sep;19(9):557-62.15.Hadlock FP, Harrist RB, Carpenter RJ, Deter RL, Park SK. Sonographic estimation of fetal weight. The value of femur length in addition to head and abdomen measurements. Radiology. 1984 Feb;150(2):535-40.16.Sovio U, White IR, Dacey A, Pasupathy D, Smith GC. Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study. Lancet. 2015 Sep 7.17.Papageorghiou AT, Ohuma EO, Altman DG, Todros T, Cheikh Ismail L, Lambert A, et al. International standards for fetal growth based on serial ultrasound measurements: the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project. Lancet. 2014 Sep 6;384(9946):869-79.18.Gardosi J, Mongelli M, Wilcox M, Chang A. An adjustable fetal weight standard. Ultrasound Obstet Gynecol. 1995 Sep;6(3):168-74.19.Mikolajczyk RT, Zhang J, Betran AP, Souza JP, Gulmezoglu AM, Merialdi M. A global reference for fetal-weight and birthweight percentiles. Lancet. 2011;377(9780):1855-61.20.Norris T, Johnson W, Farrar D, Tuffnell D, Wright J, Cameron N. Small-for-gestational age and large-for-gestational age thresholds to predict infants at risk of adverse delivery and neonatal outcomes: are current charts adequate? An observational study from the Born in Bradford cohort. BMJ Open. 2015;5(3):e006743.21.Hadlock FP, Harrist RB, Martinez-Poyer J. In utero analysis of fetal growth: a sonographic weight standard. Radiology. 1991;181(1):129-33.22.Hadlock FP, Deter RL, Harrist RB, Park SK. Estimating fetal age: computer-assisted analysis of multiple fetal growth parameters. Radiology. 1984 Aug;152(2):497-501.23.Chitty LS, Altman DG, Henderson A, Campbell S. Charts of fetal size: 3. Abdominal measurements. Br J Obstet Gynaecol. 1994 Feb;101(2):125-31.24.Villar J, Cheikh Ismail L, Victora CG, Ohuma EO, Bertino E, Altman DG, et al. International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project. Lancet. 2014 Sep 6;384(9946):857-68.25.Cole TJ, Freeman JV, Preece MA. British 1990 growth reference centiles for weight, height, body mass index and head circumference fitted by maximum penalized likelihood. Stat Med. 1998 Feb 28;17(4):407-29.26.Rutter CM, Gatsonis CA. A hierarchical regression approach to meta-analysis of diagnostic test accuracy evaluations. Stat Med. 2001;20(19):2865-84.Figure/Table LegendsFigure OneROC plot to show the estimated sensitivity and specificity of each prenatal test with each antenatal assessment and forrest plots to show the estimated negative likelihood ratios and positive likelihood ratios from the HSROC modelling.Table OneDemographic data for SGA cohort. *only 2 cases of prelabour CS were delivered due to abnormal fetal monitoring, all others were for obstetric reasons – breech, previous CS, etc.Table TwoDiagnostic accuracy of estimated fetal weight (EFW) and abdominal circumference (AC) in predicting birthweight <10th centile. Sensitivity (Sn), Specificity (Sp), Positive Likelihood Ratio (LR+), Negative Likelihood Ratio (LR-), Gestation Related Optimal Weight (GROW), Intergrow 21st (IG-21), World Health Organisation (WHO), Pregnancy Outcome Prediction (POP) study.Table ThreeDiagnostic accuracy of estimated fetal weight (EFW) and abdominal circumference (AC) in predicting adverse perinatal outcome. Gestation Related Optimal Weight (GROW), Intergrow 21st (IG-21), Pregnancy Outcome Prediction (POP) study. *5 min Apgar score of less than 7 OR metabolic acidosis (cord blood pH <7.1 and base deficit >10 mmol/L) OR term admission to the neonatal unit (admission <48 h after birth at ≥37 weeks’ gestational age and discharge ≥48 h after admission) OR stillbirth OR term livebirth associated with neonatal death OR hypoxic ischaemic encephalopathy OR use of inotropes OR need for mechanical ventilation OR severe metabolic acidosis (cord blood pH ≤7.0 and base deficit >12 mmol/L). ................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.