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41. A Comparison of Methods for the Diagnosis of Fetal Growth Restriction Between the Royal College of Obstetricians and Gynaecologists and the American College of Obstetricians and Gynecologists

A Comparison of Methods for the Diagnosis of Fetal Growth Restriction Between the Royal College of Obstetricians and Gynaecologists and the American College of Obstetricians and Gynecologists The Royal College of Obstetricians and Gynaecologists (RCOG) defines fetal growth restriction as ultrasound-estimated fetal weight less than the 10th percentile or abdominal circumference less than the 10th percentile; the American College of Obstetricians and Gynecologists (ACOG) defines fetal growth (...) 30 days of delivery. Estimated fetal weights and percentiles were calculated using the Hadlock intrauterine growth curve. Small for gestational age was defined as birth weight less than the 10th percentile based on a recent, sex-specific curve. We calculated the area under the curve, sensitivity, specificity, and positive and negative likelihood ratios for various approaches using abdominal circumference and estimated fetal weight to diagnose fetal growth restriction, including the definitions

2018 EvidenceUpdates

42. Reduced fetal growth velocities and the association with neonatal outcomes in appropriate-for-gestational-age neonates: a retrospective cohort study. (PubMed)

restriction of growth potential. We hypothesized that within AGA neonates, reduced fetal growth velocities are associated with adverse neonatal outcome.A retrospective cohort study of singleton pregnancies, in the Maastricht University Medical Centre (MUMC) between 2010 and 2016. Women had two fetal biometry scans (18-22 weeks and 30-34 weeks of gestational age) and delivered a newborn with a birth weight between the 10th-80th percentile. Differences in growth velocities of the abdominal circumference (AC (...) velocity and neonates with NICU stay (OR) = 0.733 (95%CI 0.570-0.942, p = 0.015). Neonates with a birthweight lower than expected (based on the abdominal circumference at 20 weeks) had significantly more composite adverse neonatal outcomes 8.5% vs 5.0% (p = 0.047), NICU stays 9.6% vs 3.8% (p < .0001) and hospital stays 44.4% vs 35.6% (p = 0.006).Appropriate-for-gestational-age neonates are a heterogeneous group with some showing suboptimal fetal growth. Abnormal fetal growth velocities, especially

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2019 BMC Pregnancy and Childbirth

43. Diagnostic Performance of Third Trimester Ultrasound for the Prediction of Late-Onset Fetal Growth Restriction: A Systematic Review and Meta-Analysis. (PubMed)

of Science, and SCOPUS.We used rrospective and retrospective cohort studies in low-risk or nonselected singleton pregnancies with screening ultrasound performed at ≥32 weeks of gestation.The estimated fetal weight and fetal abdominal circumference were assessed as index tests for the prediction of birthweight <10th (i.e. smallness for gestational age), less than the fifth, and less than the third centile and fetal growth restriction (estimated fetal weight less than the third or estimated fetal weight (...) <10th plus Doppler signs). Quality of the included studies was independently assessed by 2 reviewers, using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. For the meta-analysis, hierarchical summary receiver-operating characteristic curves were constructed, and quantitative data synthesis was performed using random-effects models. The sensitivity of the abdominal circumference <10th centile and estimated fetal weight <10th centile for a fixed 10% false-positive rate was derived from

2019 American Journal of Obstetrics and Gynecology

44. Gestational age at diagnosis of early-onset fetal growth restriction and impact on management and survival: a population-based cohort study

to discharge. 50% were live born when diagnosis occurred before 25 weeks, 66% at 25 weeks and >90% at 26 and 27 weeks of gestation. In all, 94.1% of live births were by prelabour caesarean, principally for maternal indications before 26 weeks. Low GA at diagnosis, an estimated fetal weight or abdominal circumference below the third centile and male sex were adversely associated with live birth in adjusted models.Gestational age at FGR diagnosis had an impact on the probability of live birth and survival (...) Gestational age at diagnosis of early-onset fetal growth restriction and impact on management and survival: a population-based cohort study To investigate the impact of gestational age (GA) at diagnosis of fetal growth restriction (FGR) on obstetric management and rates of live birth and survival for very preterm infants with early-onset FGR.Population-based cohort study.All maternity units in 25 French regions in 2011.Fetuses diagnosed with FGR before 28 weeks of gestation among singleton

2017 EvidenceUpdates

45. Does fetoscopic or open repair for spina bifida affect fetal and postnatal growth? (PubMed)

effect on the fetal, neonatal or infant biometric percentiles.Fetuses which underwent fetoscopic repair had a larger abdominal circumference percentile at referral (57 ± 21 vs 46 ± 23; P = 0.04). There were no other differences between the two groups in fetal biometric percentiles at the time of referral, 6 weeks post-surgery or at birth. There were no differences between groups in EFW percentile or in proportions of cases with birth weight < 10th and < 3rd percentiles. Linear mixed-model analysis (...) did not show any significant differences in any fetal growth parameter between the groups over time. There were no significant correlations between duration of surgery or duration of CO2 exposure and any of the biometric percentiles evaluated. Postnatal growth showed no significant differences between the groups in weight, height or head circumference percentiles, at 6-18, 18-30 or > 30 months of age.Babies exposed to fetoscopic or open MMC repair in-utero did not show significant differences

2019 Ultrasound in Obstetrics and Gynecology

46. Association of first trimester maternal vitamin D, ferritin and hemoglobin level with third trimester fetal biometry: result from cohort study on vitamin D status and its impact during pregnancy and childhood in Indonesia. (PubMed)

and 43 women (21%) were in insufficient state. Women with insufficient vitamin D had the highest proportion of anemia, while women with normal vitamin D level had the highest proportion of low ferritin level. Maternal serum vitamin D showed significant associations with biparietal diameter (β = 0.141, p = 0.042) and abdominal circumference (β = 0.819, p = 0.001) after adjustment with maternal age, pre-pregnancy body mass index, parity, serum ferritin level, and hemoglobin level.Our study suggested (...) Association of first trimester maternal vitamin D, ferritin and hemoglobin level with third trimester fetal biometry: result from cohort study on vitamin D status and its impact during pregnancy and childhood in Indonesia. The role of vitamin D in placental functions and fetal growth had been addressed in many reports with conflicting results. However, such report is limited for Indonesian population. The aim of this study was to explore the association between maternal vitamin D level

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2019 BMC Pregnancy and Childbirth

47. Etiology and perinatal outcome in periviable fetal growth restriction associated with structural or genetic anomalies. (PubMed)

Etiology and perinatal outcome in periviable fetal growth restriction associated with structural or genetic anomalies. To investigate the aetiology and the perinatal outcome of fetuses diagnosed with periviable fetal growth restriction (FGR) associated with structural defects or genetic anomalies.Retrospective study conducted at a referral Fetal Medicine unit. Singleton pregnancies seen between 2005 and 2018 in which FGR, defined by fetal abdominal circumference ≤3rd percentile

2019 Ultrasound in Obstetrics and Gynecology

48. Role of Doppler ultrasound in predicting perinatal outcome in pregnancies complicated by late-onset fetal growth restriction at the time of diagnosis: a prospective cohort study. (PubMed)

and predictive accuracy of maternal and fetal Dopplers in predicting perinatal outcome of fetuses affected by late-onset FGR at the time of diagnosis.Prospective study of consecutive singleton pregnancies complicated by late-onset FGR. Estimated fetal weight (EFW), pulsatility index (PI) in the uterine, umbilical (UA), and middle cerebral (MCA) arteries, cerebro-placental ratio (CPR) and umbilical vein flow (normalized for fetal abdominal circumference) (UVBF/AC) were recorded at the time of the diagnosis (...) Role of Doppler ultrasound in predicting perinatal outcome in pregnancies complicated by late-onset fetal growth restriction at the time of diagnosis: a prospective cohort study. Pregnancies complicated by late-onset fetal growth restriction (FGR) are at increased risk of short- and long-term morbidities. Despite this, identification of cases at higher risk of adverse perinatal outcome when FGR is diagnosed is challenging. The aims of this study were to elucidate the strength of association

2019 Ultrasound in Obstetrics and Gynecology

49. Antenatal detection of fetal growth restriction and stillbirth risk: a population-based case-control study. (PubMed)

customized standards. Detection of fetal growth restriction (FGR) was defined by the presence of at least one of seven predefined parameters (FGR or growth faltering mentioned in medical records or ultrasound reports, documented abdominal circumference or estimated fetal weight <10th percentile, prescription of additional ultrasounds to monitor growth or abnormal umbilical Doppler). We used logistic regression to estimate crude and adjusted odds ratios (OR) of the association of detection with stillbirth (...) Antenatal detection of fetal growth restriction and stillbirth risk: a population-based case-control study. Antenatal surveillance of intrauterine growth aims to detect growth restricted fetuses who face higher risks of stillbirth. Improving detection could be an effective strategy for stillbirth prevention. The REPERE study was conducted to estimate the association between antenatal detection of small for gestational age (SGA) and stillbirth risk in France.REPERE is a case-control study

2019 Ultrasound in Obstetrics and Gynecology

50. STRIDER NZAus: A multicentre randomised controlled trial of sildenafil therapy in early-onset fetal growth restriction. (PubMed)

, adjusted OR 0.49, 95% CI 0.23-1.05 and had no effect on abdominal circumference Z-scores (p=0.61). Sildenafil use was associated with a lower mean uterine pulsatility index after 48 hours treatment (1.56 vs 1.81 p=0.02). The livebirth rate was 56/63 (88.9%) sildenafil-treated 47/59 (79.7%) placebo-treated, adjusted OR 2.50 (95%CI 0.80-7.79); survival to hospital discharge free of major neonatal morbidity was 42/63 (66.7%) sildenafil-treated 33/59 (55.9%) placebo-treated, adjusted OR 1.93 (0.84-4.45 (...) STRIDER NZAus: A multicentre randomised controlled trial of sildenafil therapy in early-onset fetal growth restriction. To assess the effect of maternal sildenafil therapy on fetal growth in pregnancies with early-onset fetal growth restriction.A randomised placebo-controlled trial.Thirteen maternal-fetal medicine units across New Zealand and Australia.Women with singleton pregnancies affected by fetal growth restriction at 22+0 to 29+6 weeks.Women were randomised to oral 25mg sildenafil

2019 BJOG Controlled trial quality: predicted high

51. Effect of sildenafil on maternal hemodynamics in pregnancies complicated by severe early-onset fetal growth restriction: planned subgroup analysis from a multicenter randomized placebo-controlled double-blind trial. (PubMed)

, the Dutch trial was stopped prematurely due to excess neonatal mortality secondary to pulmonary hypertension. The main aim of this study was to investigate the effect of sildenafil on maternal hemodynamics in pregnancies with severe early-onset FGR.In this UK multicenter, placebo-controlled trial, we randomly assigned 135 women with singleton pregnancies and severe early-onset FGR (defined as a combination of estimated fetal weight or abdominal circumference below the 10th centile and absent/reversed (...) Effect of sildenafil on maternal hemodynamics in pregnancies complicated by severe early-onset fetal growth restriction: planned subgroup analysis from a multicenter randomized placebo-controlled double-blind trial. Fetal growth restriction (FGR) is associated with maternal cardiovascular changes. Sildenafil, a phosphodiesterase type 5 inhibitor, potentiates the actions of nitric oxide and has been proposed to alter maternal hemodynamics, potentially improving placental perfusion. Recently

2019 Ultrasound in Obstetrics and Gynecology Controlled trial quality: predicted high

52. Associations between estimated foetal weight discordance and clinical characteristics within dichorionic twins: The NICHD Fetal Growth Studies. (PubMed)

Associations between estimated foetal weight discordance and clinical characteristics within dichorionic twins: The NICHD Fetal Growth Studies. Birthweight discordance is well studied, with less known about longitudinal inter-twin differences in foetal growth.To examine inter-twin per cent differences in EFW (EFW% ), head (HC% ) and abdominal circumference (AC% ), and femur length (FL% ) across gestation in dichorionic twin gestations and explore associated characteristics.Foetal biometrics (...) were assessed by ultrasound and EFW calculated at ≤6 study visits among women with dichorionic twin pregnancies enrolled in the NICHD Fetal Growth Studies cohort (US, 2012-2013). Inter-twin per cent difference was defined: ([Sizelarger twin  - Sizesmaller twin ]/Sizelarger twin  × 100). Linear mixed models evaluated per cent differences in foetal biometrics at 15 weeks and their change per week overall and by maternal/neonatal characteristics in unadjusted and adjusted models.In 140 pregnancies

2019 Paediatric and perinatal epidemiology

53. Blood-based biomarkers in the maternal circulation associated with fetal growth restriction. (PubMed)

Blood-based biomarkers in the maternal circulation associated with fetal growth restriction. Fetal growth restriction (FGR) is associated with threefold to fourfold increased risk of stillbirth. Identifying FGR, through its commonly used surrogate-the small-for-gestational-age (SGA, estimated fetal weight and/or abdominal circumference <10th centile) fetus-and instituting fetal surveillance and timely delivery decrease stillbirth risk. Methods available to clinicians for antenatal

2019 Prenatal diagnosis

54. Maternal cardiometabolic markers are associated with fetal growth: a secondary exploratory analysis of the LIMIT randomised trial. (PubMed)

of registration 9/03/2007, prospectively registered). Fetal biometry including abdominal circumference (AC), estimated fetal weight (EFW), and adiposity measurements (mid-thigh fat mass, subscapular fat mass, abdominal fat mass) were obtained from ultrasound assessments at 28 and 36 weeks' gestation. Maternal markers included C reactive protein (CRP), leptin and adiponectin concentrations, measured at 28 and 36 weeks' gestation and fasting triglycerides and glucose concentrations measured at 28 weeks (...) Maternal cardiometabolic markers are associated with fetal growth: a secondary exploratory analysis of the LIMIT randomised trial. To determine the association between maternal cardiometabolic and inflammatory markers with measures of fetal biometry and adiposity.Women included in this exploratory analysis were randomised to the 'Standard Care' group (N = 911) from the LIMIT randomised trial involving a total of 2212 pregnant women who were overweight or obese (ACTRN12607000161426, Date

2019 BMC Endocrine Disorders

55. Trajectories of Fetal Adipose Tissue Thickness in Pregnancies After Gastric Bypass Surgery. (PubMed)

Trajectories of Fetal Adipose Tissue Thickness in Pregnancies After Gastric Bypass Surgery. Recent studies showed that women after surgery are at higher risk of delivering small-for-gestational infants. Thus, this study aims to investigate longitudinal changes of fetal subcutaneous adipose tissue thickness (FSCTT) of fetuses conceived after gastric bypass surgery as compared to BMI-matched controls.Retrospective cohort study measuring ultrasound-derived longitudinal trajectories of abdominal (...) and abdominal circumference remained constant in the BMI-matched control group whereas it significantly decreased in fetuses of women after GB. Despite remarkable differences were observed in longitudinally assessed FSCTT, further analyses in the GB subgroup revealed that FSCTT were not influenced by OGTT mean or 120 min glucose values, biochemically hypoglycemia, time since bariatric surgery, or weight loss since surgery.In fetuses of mothers with history of bariatric surgery, abdominal FSCTT was markedly

2019 Obesity Surgery

56. Fetal Hemodynamics and Fetal Growth Indices by Ultrasound in Late Pregnancy and Birth Weight in Gestational Diabetes Mellitus (PubMed)

women with GDM and 124 normal controls (NC) were enrolled in this study. Fetal hemodynamic indices, including the systolic/diastolic ratio (S/D), resistance index (RI), pulsatility index (PI) of umbilical artery (UA), middle cerebral artery (MCA), and renal artery (RA), were collected. Fetal growth indices, including biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length, were also measured by ultrasound. Birth weight, newborn gender, and maternal clinical (...) Fetal Hemodynamics and Fetal Growth Indices by Ultrasound in Late Pregnancy and Birth Weight in Gestational Diabetes Mellitus The offspring of women with gestational diabetes mellitus (GDM) are prone to macrosomia. However, birth weight is difficult to be correctly estimated by ultrasound because of fetal asymmetric growth characteristics. This study aimed to investigate the correlations between fetal hemodynamics, fetal growth indices in late pregnancy, and birth weight in GDM.A total of 147

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2016 Chinese medical journal

57. Influence of fetal blood flow redistribution on fetal and childhood growth and fat distribution: the Generation R Study. (PubMed)

circumference, length and weight from third trimester fetal life until childhood (all P < 0.05). The fetal U/C ratio was not associated with total body and abdominal fat measures at 6 years.Our results suggest that fetal blood flow redistribution affects fetal development and has persistent consequences for childhood growth.Fetal blood flow redistribution affects fetal development and has persistent consequences for childhood growth.© 2016 Royal College of Obstetricians and Gynaecologists. (...) Influence of fetal blood flow redistribution on fetal and childhood growth and fat distribution: the Generation R Study. A suboptimal intrauterine environment leads to fetal blood flow redistribution and fetal growth restriction. Not much is known about childhood growth consequences. We examined the associations of fetal blood flow redistribution with birth outcomes, and repeatedly measured fetal and childhood growth and fat mass measures.Prospective cohort study.Population-based.One thousand

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2016 BJOG

58. Detection and measurement of fetal abdominal contour in ultrasound images via local phase information and iterative randomized Hough transform. (PubMed)

Detection and measurement of fetal abdominal contour in ultrasound images via local phase information and iterative randomized Hough transform. Due to the characteristic artifacts of ultrasound images, e.g., speckle noise, shadows and intensity inhomogeneity, traditional intensity-based methods usually have limited success on the segmentation of fetal abdominal contour. This paper presents a novel approach to detect and measure the abdominal contour from fetal ultrasound images in two steps (...) . First, a local phase-based measure called multiscale feature asymmetry (MSFA) is de ned from the monogenic signal to detect the boundaries of fetal abdomen. The MSFA measure is intensity invariant and provides an absolute measurement for the signi cance of features in the image. Second, in order to detect the ellipse that ts to the abdominal contour, the iterative randomized Hough transform is employed to exclude the interferences of the inner boundaries, after which the detected ellipse gradually

2014 Bio-medical materials and engineering

59. The validity of the viscero-abdominal disproportion ratio for type of surgical closure in all fetuses with an omphalocele. (PubMed)

The validity of the viscero-abdominal disproportion ratio for type of surgical closure in all fetuses with an omphalocele. To determine the predictive value of the fetal omphalocele circumference/abdominal circumference (OC/AC) ratio for type of surgical closure and survival and to describe the trajectory of OC/AC ratio throughout gestation.This cohort study included all live-born infants prenatally diagnosed with an omphalocele in our tertiary centre (2000-2017) with an intention to treat

2019 Prenatal diagnosis

60. Diagnosis and Treatment of Fetal Cardiac Disease

(estimated >1% but <2% absolute risk) Maternal medications Anticonvulsants Lithium Vitamin A SSRIs (only paroxetine) NSAIDs in first/second trimester CHD in second degree relative of fetus Fetal abnormality of the umbilical cord or placenta Fetal intra-abdominal venous anomaly Not indicated (≤1% risk) Maternal gestational diabetes mellitus with HbA 1c <6% Maternal medications SSRIs (other than paroxetine) Vitamin K agonists (Coumadin), although fetal survey is recommended Maternal infection other than (...) photocoagulation of the intertwin anastomosis. , , Fetal echocardiogram is recommended in all monochorionic twin gestations. Nonimmune Hydrops Fetalis and Effusions Fetal hydrops refers to the pathological accumulation of fluid in ≥2 fetal compartments, including the pleural or pericardial spaces, abdominal cavity, integument, or placenta. The mechanism of the development of hydrops in the fetus is thought to be a combination of increased hydrostatic pressure, decreased oncotic pressure, and in some, lymphatic

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2014 American Heart Association

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