Mednax Center for Research, Education, Quality and Safety, Sunrise, Florida (Dr Combs); Obstetrix Medical Group, San Jose, CA (Dr Combs and Ms del Rosario).
Regional Obstetric Consultants (Mednax), Jacksonville, Florida (Dr Castillo).
Am J Obstet Gynecol MFM. 2021 Jul;3(4):100382. doi: 10.1016/j.ajogmf.2021.100382. Epub 2021 Apr 27.
Fetal growth restriction has traditionally been defined as fetuses with an estimated fetal weight <10th percentile for gestational age. In 2020, the Society for Maternal-Fetal Medicine recommended that the definition be expanded to include either an estimated fetal weight<10th percentile or a fetal abdominal circumference<10th percentile.
We sought to determine the impact of adding the criterion abdominal circumference<10th percentile on the rate of diagnosis of fetal growth restriction vs using the criterion estimated fetal weight<10th percentile alone. In addition, we evaluated the definition proposed by Copel and Bahtiyar, estimated fetal weight<10th percentile or abdominal circumference<5th percentile.
This was a retrospective, descriptive study from 3 consultative maternal-fetal medicine practices. Biometry was compiled from ultrasound examinations from January 2019 to July 2020. The inclusion criteria were singleton pregnancy, gestational age of ≥24 weeks, presence of fetal cardiac activity, and presence of 4 standard fetal biometry parameters (biparietal diameter, head circumference, abdominal circumference, and femur length). We tabulated the indications for the examinations and the number of examinations meeting several criteria for the diagnosis of fetal growth restriction: Traditional criterion (estimated fetal weight<10th percentile), Copel-Bahtiyar criteria (estimated fetal weight<10th percentile or abdominal circumference<5th percentile), and Society for Maternal-Fetal Medicine criteria (estimated fetal weight<10th percentile or abdominal circumference<10th percentile).
During the study period, 20,633 ultrasound examinations met the inclusion criteria. In 62% of examinations, there was ≥1 factor for fetal growth restriction, and in 51% of examinations, there was ≥1 factor for large for gestational age. The rate of estimated fetal weight<10th percentile was 9.7%. The rate of abdominal circumference<5th percentile was 5.7%, and the rate of abdominal circumference<10th percentile was 9.2%. The rate of fetal growth restriction was 9.7% using the traditional definition (estimated fetal weight<10th percentile only). The rate of fetal growth restriction was 10.2% using the Copel-Bahtiyar definition (estimated fetal weight<10th percentile or abdominal circumference<5th percentile), significantly higher than using the traditional definition (P<.001). The rate of fetal growth restriction was 11.6% using the Society for Maternal-Fetal Medicine definition (estimated fetal weight<10th percentile or abdominal circumference<10th percentile), significantly higher than using either the traditional or Copel-Bahtiyar definition (P<.001 for both). Among examinations with an abdominal circumference<10th percentile, 79% also had an estimated fetal weight<10th percentile and was considered fetal growth restriction even without considering abdominal circumference.
Adding the criterion abdominal circumference<5th percentile or abdominal circumference<10th percentile to the definition of fetal growth restriction resulted in a statistically significant increase in the rate of diagnosis of fetal growth restriction. However, the absolute increase in the rate was small and was not expected to place a large burden on practice resources.
胎儿生长受限传统上定义为估计胎儿体重<孕龄第 10 百分位。2020 年，母胎医学学会建议将定义扩展为包括估计胎儿体重<第 10 百分位或胎儿腹围<第 10 百分位。
我们旨在确定添加标准腹围<第 10 百分位与单独使用估计胎儿体重<第 10 百分位标准对胎儿生长受限诊断率的影响。此外，我们评估了 Copel 和 Bahtiyar 提出的定义，即估计胎儿体重<第 10 百分位或腹围<第 5 百分位。
这是一项来自 3 个咨询母胎医学实践的回顾性描述性研究。超声检查的生物测量数据来自 2019 年 1 月至 2020 年 7 月的超声检查。纳入标准为单胎妊娠、孕龄≥24 周、存在胎儿心脏活动和存在 4 个标准胎儿生物测量参数（双顶径、头围、腹围和股骨长）。我们列出了检查的指征和符合胎儿生长受限诊断标准的检查数量：传统标准（估计胎儿体重<第 10 百分位）、Copel-Bahtiyar 标准（估计胎儿体重<第 10 百分位或腹围<第 5 百分位）和母胎医学学会标准（估计胎儿体重<第 10 百分位或腹围<第 10 百分位）。
在研究期间，20633 次超声检查符合纳入标准。在 62%的检查中存在≥1 个胎儿生长受限的因素，在 51%的检查中存在≥1 个巨大儿的因素。估计胎儿体重<第 10 百分位的发生率为 9.7%。腹围<第 5 百分位的发生率为 5.7%，腹围<第 10 百分位的发生率为 9.2%。使用传统定义（仅估计胎儿体重<第 10 百分位），胎儿生长受限的发生率为 9.7%。使用 Copel-Bahtiyar 定义（估计胎儿体重<第 10 百分位或腹围<第 5 百分位），胎儿生长受限的发生率为 10.2%，显著高于传统定义（P<.001）。使用母胎医学学会定义（估计胎儿体重<第 10 百分位或腹围<第 10 百分位），胎儿生长受限的发生率为 11.6%，显著高于传统定义或 Copel-Bahtiyar 定义（两者均 P<.001）。在腹围<第 10 百分位的检查中，79%也有估计胎儿体重<第 10 百分位，如果不考虑腹围，也被认为是胎儿生长受限。
将腹围<第 5 百分位或腹围<第 10 百分位标准添加到胎儿生长受限的定义中，导致胎儿生长受限的诊断率有统计学意义的增加。然而，绝对增长率很小，预计不会给实践资源带来很大负担。
