Perinatal outcomes after selective third-trimester ultrasound screening for small-for-gestational age: prospective cohort study nested within DESiGN randomized controlled trial.

In screening for small-for-gestational age (SGA) using third-trimester antenatal ultrasound, there are concerns about the low detection rates and potential for harm caused by both false-negative and false-positive screening results. Using a selective third-trimester ultrasound screening program, this study aimed to investigate the incidence of adverse perinatal outcomes among cases with (i) false-negative compared with true-positive SGA diagnosis and (ii) false-positive compared with true-negative SGA diagnosis. This prospective cohort study was nested within the UK-based DESiGN trial, a prospective multicenter cohort study of singleton pregnancies without antenatally detected fetal anomalies, born at > 24 + 0 to < 43 + 0 weeks' gestation. We included women recruited to the baseline period, or control arm, of the trial who were not exposed to the Growth Assessment Protocol intervention and whose birth outcomes were known. Stillbirth and major neonatal morbidity were the two primary outcomes. Minor neonatal morbidity was considered a secondary outcome. Suspected SGA was defined as an estimated fetal weight (EFW) < 10th percentile, based on the Hadlock formula and fetal growth charts. Similarly, SGA at birth was defined as birth weight (BW) < 10th percentile, based on UK population references. Maternal and pregnancy characteristics and perinatal outcomes were reported according to whether SGA was suspected antenatally or not. Unadjusted and adjusted logistic regression models were used to quantify the differences in adverse perinatal outcomes between the screening results (false negative vs true positive and false positive vs true negative). In total, 165 321 pregnancies were included in the analysis. Fetuses with a false-negative SGA screening result, compared to those with a true-positive result, were at a significantly higher risk of stillbirth (adjusted odds ratio (aOR), 1.18 (95% CI, 1.07-1.31)), but at lower risk of major (aOR, 0.87 (95% CI, 0.83-0.91)) and minor (aOR, 0.56, (95% CI, 0.54-0.59)) neonatal morbidity. Compared with a true-negative screening result, a false-positive result was associated with a lower BW percentile (median, 18.1 (interquartile range (IQR), 13.3-26.9) vs 49.9 (IQR, 30.3-71.7)). A false-positive result was also associated with a significantly increased risk of stillbirth (aOR, 2.24 (95% CI, 1.88-2.68)) and minor neonatal morbidity (aOR, 1.60 (95% CI, 1.51-1.71)), but not major neonatal morbidity (aOR, 1.04 (95% CI, 0.98-1.09)). In selective third-trimester ultrasound screening for SGA, both false-negative and false-positive results were associated with a significantly higher risk of stillbirth, when compared with true-positive and true-negative results, respectively. Improved SGA detection is needed to address false-negative results. It should be acknowledged that cases with a false-positive SGA screening result also constitute a high-risk population of small fetuses that warrant surveillance and timely birth. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Winsloe C ，Elhindi J ，Vieira MC ，Relph S ，Arcus CG ，Coxon K ，Briley A ，Johnson M ，Page LM ，Shennan A ，Marlow N ，Lees C ，Lawlor DA ，Khalil A ，Sandall J ，Copas A ，Pasupathy D ， on behalf of the DESiGN Trial Team ... -  《-》

Routine 36-week scan: prediction of small-for-gestational-age neonate.

First, to compare the predictive performance of routine ultrasonographic estimated fetal weight (EFW) at 31 + 0 to 33 + 6 and 35 + 0 to 36 + 6 weeks' gestation for delivery of a small-for-gestational-age (SGA) neonate. Second, to compare the predictive performance of EFW at 36 weeks' gestation for SGA vs fetal growth restriction (FGR) at birth. Third, to compare the predictive performance for delivery of a SGA neonate of EFW < 10th percentile vs a model combining maternal demographic characteristics and elements of medical history with EFW. This was a retrospective analysis of prospectively collected data in 21 676 women with a singleton pregnancy who had undergone routine ultrasound examination at 31 + 0 to 33 + 6 weeks' gestation and 107 875 women with a singleton pregnancy who had undergone routine ultrasound examination at 35 + 0 to 36 + 6 weeks. Measurements of fetal head circumference, abdominal circumference and femur length were used to calculate EFW according to the Hadlock formula and this was expressed as a percentile according to the Fetal Medicine Foundation fetal and neonatal population weight charts. The same charts were used to diagnose SGA neonates with birth weight < 10th or < 3rd percentile. FGR was defined as birth weight < 10th percentile in addition to Doppler anomalies. For each gestational-age window at screening, the screen-positive rate and detection rate were calculated at different EFW cut-offs between the 10th and 50th percentiles for predicting the delivery of a SGA neonate with birth weight < 10th or < 3rd percentile, either within 2 weeks or at any time after assessment. The areas under the receiver-operating-characteristics curves (AUC) of screening for a SGA neonate by EFW at 31 + 0 to 33 + 6 weeks and at 35 + 0 to 36 + 6 weeks were compared. The predictive performance of routine ultrasonographic examination during the third trimester for delivery of a SGA neonate is higher if: first, the scan is carried out at 35 + 0 to 36 + 6 weeks' gestation rather than at 31 + 0 to 33 + 6 weeks; second, the outcome measure is birth weight < 3rd rather than < 10th percentile; third, the outcome measure is FGR rather than SGA; fourth, if delivery occurs within 2 weeks after assessment rather than at any time after assessment; and fifth, prediction is performed using a model that combines maternal demographic characteristics and elements of medical history with EFW rather than EFW < 10th percentile alone. At 35 + 0 to 36 + 6 weeks' gestation, detection of ≥ 85% of SGA neonates with birth weight < 10th percentile born at any time after assessment necessitates the use of EFW < 40th percentile. Screening at this percentile cut-off predicted 95% and 98% of neonates with birth weight < 10th and < 3rd percentile, respectively, born within 2 weeks after assessment, and the respective values for neonates born at any time after assessment were 85% and 93%. Routine third-trimester ultrasonographic screening for a SGA neonate performs best when the scan is carried out at 35 + 0 to 36 + 6 weeks' gestation, rather than at 31 + 0 to 33 + 6 weeks, and when EFW is combined with maternal risk factors to estimate the patient-specific risk. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Adjahou S ，Syngelaki A ，Nanda M ，Papavasileiou D ，Akolekar R ，Nicolaides KH ... -  《-》

Development and validation of prediction models for fetal growth restriction and birthweight: an individual participant data meta-analysis.

Allotey J ，Archer L ，Coomar D ，Snell KI ，Smuk M ，Oakey L ，Haqnawaz S ，Betrán AP ，Chappell LC ，Ganzevoort W ，Gordijn S ，Khalil A ，Mol BW ，Morris RK ，Myers J ，Papageorghiou AT ，Thilaganathan B ，Da Silva Costa F ，Facchinetti F ，Coomarasamy A ，Ohkuchi A ，Eskild A ，Arenas Ramírez J ，Galindo A ，Herraiz I ，Prefumo F ，Saito S ，Sletner L ，Cecatti JG ，Gabbay-Benziv R ，Goffinet F ，Baschat AA ，Souza RT ，Mone F ，Farrar D ，Heinonen S ，Salvesen KÅ ，Smits LJ ，Bhattacharya S ，Nagata C ，Takeda S ，van Gelder MM ，Anggraini D ，Yeo S ，West J ，Zamora J ，Mistry H ，Riley RD ，Thangaratinam S ... -  《-》

Defining the optimum strategy for identifying adults and children with coeliac disease: systematic review and economic modelling.

Elwenspoek MM ，Thom H ，Sheppard AL ，Keeney E ，O'Donnell R ，Jackson J ，Roadevin C ，Dawson S ，Lane D ，Stubbs J ，Everitt H ，Watson JC ，Hay AD ，Gillett P ，Robins G ，Jones HE ，Mallett S ，Whiting PF ... -  《-》

Role of routine uterine artery Doppler at 18-22 and 24-28 weeks' gestation following routine first-trimester screening for pre-eclampsia.

To assess the performance of mean uterine artery pulsatility index (UtA-PI) at 18-22 and 24-28 weeks of gestation in the prediction of pre-eclampsia (PE) and small-for-gestational age (SGA), and its role in reassessing the risk of PE and SGA in pregnancies screened for PE in the first trimester. This was a retrospective observational cohort study of 4464 women with singleton pregnancy screened routinely for PE in the first trimester, using the Gaussian algorithm, from March 2019 to May 2021, and who underwent UtA-PI assessment at 18-22 gestational weeks. Women were categorized as low risk or high risk based on the risk index obtained after first-trimester screening for PE. In high-risk patients, UtA-PI was also assessed at 24-28 weeks of gestation. Sensitivity, specificity, positive predictive value, negative predictive value (NPV), positive likelihood ratio, negative likelihood ratio and area under the receiver-operating-characteristics curve were calculated to assess the performance of UtA-PI at 18-22 and 24-28 weeks in predicting PE and SGA in the high-risk group. In all participants, different UtA-PI percentiles at 18-22 or 24-28 weeks, or their combination, were analyzed to explore their role in reassessing the risk of PE and SGA following first-trimester PE screening. The performance of UtA-PI at 18-22 and 24-28 weeks in the high-risk group was good for predicting preterm PE and preterm SGA, and excellent for predicting early-onset PE and early-onset SGA, with an NPV of > 97% for all outcomes. In the low-risk group, UtA-PI ≥ 95th percentile at 18-22 weeks' gestation identified a subgroup of pregnancies with a significantly higher risk of preterm SGA compared to the low-risk group. In the high-risk group, UtA-PI < 60th percentile at 18-22 weeks' gestation, UtA-PI < 85th percentile at 24-28 weeks' gestation, and UtA-PI < 85th percentile at 24-28 weeks' gestation in women with UtA-PI ≥ 60th percentile at 18-22 weeks, identified subgroups of pregnancies with a risk of PE and SGA comparable to that of the low-risk group. The performance of UtA-PI at 18-22 and 24-28 gestational weeks in high-risk pregnancies identified during first-trimester screening for PE is similar to that in the general population. The risk of PE and SGA in a high-risk cohort can be reassessed by measuring UtA-PI at 18-22 weeks, 24-28 weeks or both, allowing adjustment of follow-up, particularly de-escalation of care. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Bonacina E ，Del Barco E ，Farràs A ，Dalmau M ，Garcia E ，Gleeson-Vallbona L ，Serrano B ，Armengol-Alsina M ，Catalan S ，Hernadez A ，San José M ，Miserachs M ，Millan P ，Garcia-Manau P ，Carreras E ，Mendoza M ... -  《-》