Can Abdominal Circumference Alone Be Used to Predict SGA or LGA Newborns?
BACKGROUND AND PURPOSE:
Guidelines recommend using estimated fetal weight (EFW) for growth which is comprised of:
Abdominal Circumference (AC)
Blue et. al. (American Journal of Perinatology, 2017) compared the sensitivity and specificity of abdominal circumference (AC) found in the literature against composite EFW to predict small for gestational age (SGA) or large for gestational age (LGA) newborns
Literature analysis of 40 studies with ultrasonographic AC or EFW
Prospective or retrospective study design published in 1995 or later
≥ 24 weeks gestation
SGA defined as birth weight < 10th percentile or <2,500 g at term
LGA defined as birth weight > 90th percentile or >4,000 g
Anomalous fetuses excluded due to difficulty in optimal measurement
To predict SGA: AC < 10th percentile, AC < 5th percentile, EFW < 10th percentile, EFW < 2.5 kg
To predict LGA: AC >35 cm, AC > 90th percentile, AC > 95th percentile, EFW > 4 kg, EFW > 90th percentile
To predict SGA, AC and EFW <10th percentile have similar performance characteristics
To predict LGA, AC cutoffs were comparable to EFW cutoffs, but performed better with better sensitivity when AC >35 cm
After 24 weeks, AC is comparable to EFW to predict both SGA and LGA, particularly PPV and NPVs
Compared to EFW, AC takes less time and training
The authors do not recommend replacing EFWs but suggest AC measurement may be helpful in areas with limited access to ultrasound
The authors conclude that this study supports RCOG’s recommendation that AC < 10th percentile can be used as a diagnostic criterion for growth restriction as opposed to ACOG that recommends the use of EFW < 10th percentile only
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