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Grand Rounds

Are New Predictors of Fetal Weight Superior to Traditional Ultrasound?

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BACKGROUND AND PURPOSE:

  • 2 common components used to identify SGA include
    • EFW
    • Growth curve to determine percentile
  • Hadlock (US derived growth curve) remains an ultrasound standard, however there are 2 new curves using alternate formulae that may be more generalizable
    • Intergrowth-21st (INTG) method (international population)
    • Salomon method (Paris, France population)
  • Blue et al. (Journal of Ultrasound in Medicine, 2018) compared the traditional Hadlock method with these 2 newer methods for the SGA

METHODS:

  • Retrospective review
    • Singleton, non-anomalous, well-dates fetuses were examined within 2 weeks of delivery
  • Fetal growth restriction (FGR): EFW <10th percentile
  • SGA: Birth weight <10th percentile
  • Estimated fetal weights and percentiles were calculated by
    • Hadlock method
    • INTG method
    • Salomon method
  • Outcomes: Test characteristics to predict SGA were calculated using
    • EFW < 10th percentile (standard method)
    • Receiver operating characteristic (ROC) – derived FGR cutoffs

RESULTS:

  • 831 pregnancies
    • SGA: 16.7%
  • Plotting the ROC curves using a 10th percentile cutoff, Hadlock performed better than the other methods in the prediction of SGA
  • Comparing overall performance and accuracy of birth weight percentile prediction
    • Hadlock and INTG methods performed comparably (P = .08)
    • Hadlock area under the curve: 0.91
    • INTG area under the curve: 0.90
  • Optimal EFW cutoffs
    • Hadlock: 15th percentile
    • INTG: 22nd percentile
  • Salomon method performed less well than other 2 methods (P<.001)
    • Area under the curve: 0.82

CONCLUSION:

  • The traditional Hadlock had the best sensitivity and ROCs to predict SGA (using 10% cutoff)
  • Hadlock was comparable to INTG for the prediction of SGA when ROC‐derived cutoffs were used
  • Using a 15th percentile cutoff for Hadlock EFW or 22nd percentile for INTG EFW may improve the ability of ultrasound to predict SGA

Learn More – Primary Sources:

The Hadlock Method Is Superior to Newer Methods for the Prediction of the Birth Weight Percentile

INTERGROWTH-21st: The International Fetal and Newborn Growth Consortium

 

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Related ObG Topics:

RCOG or ACOG for Predicting Small for Gestational Age Birth?
How Accurate are Estimated Fetal Weight Ultrasound Measurements between 23 and 25 Weeks?
Can Fetal Head Size Help Predict Risk of Cesarean Section?

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