Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.
Monash Women's, Monash Health, Melbourne, Victoria, Australia.
Aust N Z J Obstet Gynaecol. 2023 Jun;63(3):321-327. doi: 10.1111/ajo.13620. Epub 2022 Oct 2.
Antenatal detection of fetal growth restriction allows the opportunity to increase surveillance and initiate intervention to prevent adverse outcomes. Detection of small for gestational age (SGA) fetuses with risk factor screening and selective ultrasonography is the standard of care in Australia, but evidence regarding performance is lacking.
To evaluate the diagnostic performance of a risk factor-based screening approach in detection of SGA neonates.
Retrospective cohort study conducted in a metropolitan maternity service, including all consecutive singleton deliveries over 20 weeks gestation from July 2016 to December 2017, and excluding terminations of pregnancy. An SGA neonate was defined by birthweight below the tenth percentile according to Australian reference ranges. Antenatally detected SGA cases were defined by estimated fetal weight or abdominal circumference below the tenth percentile for gestational age, or abnormal symphysio-fundal height. The diagnostic accuracy of the screening protocol was calculated using detection rates and false-positive rates.
There were 13 384 singleton pregnancies included. There were 1330 infants (10.0%) who were SGA at birth. Antenatal detection rate of SGA neonates was 39.6% (95% confidence interval (CI) 37.0-42.3%), with a false-positive rate of 10.2% (95% CI 9.6-10.7%). There were 10 266 pregnancies (77.0%) which had at least one risk factor for an SGA infant. Of these, 6650 (64.8%) underwent at least one fetal growth ultrasound after 24 weeks gestation.
Antenatal recognition of poor fetal growth is suboptimal using our current screening protocol. Three-quarters of pregnancies demonstrated risk factors for delivering an SGA infant, but growth ultrasonography may be underutilised.
产前检测胎儿生长受限可增加监测机会并启动干预措施，以预防不良结局。在澳大利亚，通过危险因素筛查和选择性超声检查检测小胎龄儿（SGA）是标准的护理方法，但缺乏相关证据。
评估基于危险因素的筛查方法在检测 SGA 新生儿中的诊断性能。
这是一项在大都会产科服务机构进行的回顾性队列研究，纳入了 2016 年 7 月至 2017 年 12 月期间所有连续 20 周以上的单胎分娩，不包括终止妊娠的病例。SGA 新生儿的定义为根据澳大利亚参考范围，出生体重低于第 10 个百分位数。产前检测的 SGA 病例定义为估计胎儿体重或腹围低于相应胎龄的第 10 个百分位数，或脐耻间距离异常。使用检出率和假阳性率计算筛查方案的诊断准确性。
共纳入 13384 例单胎妊娠，其中 1330 例（10.0%）新生儿出生时为 SGA。SGA 新生儿的产前检出率为 39.6%（95%可信区间[CI] 37.0-42.3%），假阳性率为 10.2%（95% CI 9.6-10.7%）。有 10266 例（77.0%）妊娠至少存在一个 SGA 婴儿的危险因素。其中，6650 例（64.8%）在 24 周后至少进行了一次胎儿生长超声检查。
使用我们现有的筛查方案，产前识别胎儿生长不良的效果并不理想。四分之三的妊娠存在分娩 SGA 婴儿的危险因素，但生长超声检查的利用率可能较低。
