R Akolekar1,2, M Tokunaka1, N Ortega1, A Syngelaki1, K H Nicolaides1. 1. Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK. 2. Department of Fetal Medicine, Medway Maritime Hospital, Gillingham, UK.
Abstract
OBJECTIVES: To evaluate the performance of screening for all stillbirths and those due to impaired placentation and unexplained or other causes using a combination of maternal factors, fetal biometry and uterine artery pulsatility index (UtA-PI) at 19-24 weeks' gestation and to compare this performance with that of screening by UtA-PI alone. METHODS: This was a prospective screening study of 70 003 singleton pregnancies including 69 735 live births and 268 (0.38%) antepartum stillbirths; 159 (59%) were secondary to impaired placentation and 109 (41%) were due to other or unexplained causes. Multivariable logistic regression analysis was used to develop a model for prediction of stillbirth based on a combination of maternal factors, fetal biometry and UtA-PI. RESULTS: Combined screening predicted 55% of all stillbirths, including 75% of those due to impaired placentation and 23% of those that were unexplained or due to other causes, at a false-positive rate of 10%. Within the impaired placentation group, the detection rate of stillbirth < 32 weeks' gestation was higher than that of stillbirth ≥ 37 weeks (88% vs 46%; P < 0.001). The performance of screening by the combined test was superior to that of selecting the high-risk group on the basis of UtA-PI > 90th percentile for gestational age, which predicted 48% of all stillbirths, 70% of those due to impaired placentation and 15% of those that were unexplained or due to other causes. CONCLUSIONS: Second-trimester screening by a combination of UtA-PI with maternal factors and fetal biometry can predict a high proportion of stillbirths and, in particular, those that are due to impaired placentation.
OBJECTIVES: To evaluate the performance of screening for all stillbirths and those due to impaired placentation and unexplained or other causes using a combination of maternal factors, fetal biometry and uterine artery pulsatility index (UtA-PI) at 19-24 weeks' gestation and to compare this performance with that of screening by UtA-PI alone. METHODS: This was a prospective screening study of 70 003 singleton pregnancies including 69 735 live births and 268 (0.38%) antepartum stillbirths; 159 (59%) were secondary to impaired placentation and 109 (41%) were due to other or unexplained causes. Multivariable logistic regression analysis was used to develop a model for prediction of stillbirth based on a combination of maternal factors, fetal biometry and UtA-PI. RESULTS: Combined screening predicted 55% of all stillbirths, including 75% of those due to impaired placentation and 23% of those that were unexplained or due to other causes, at a false-positive rate of 10%. Within the impaired placentation group, the detection rate of stillbirth < 32 weeks' gestation was higher than that of stillbirth ≥ 37 weeks (88% vs 46%; P < 0.001). The performance of screening by the combined test was superior to that of selecting the high-risk group on the basis of UtA-PI > 90th percentile for gestational age, which predicted 48% of all stillbirths, 70% of those due to impaired placentation and 15% of those that were unexplained or due to other causes. CONCLUSIONS: Second-trimester screening by a combination of UtA-PI with maternal factors and fetal biometry can predict a high proportion of stillbirths and, in particular, those that are due to impaired placentation.
Authors: Amanda S Trudell; Methodius G Tuuli; Graham A Colditz; George A Macones; Anthony O Odibo Journal: PLoS One Date: 2017-03-07 Impact factor: 3.240
Authors: Rosalind Aughwane; Emma Ingram; Edward D Johnstone; Laurent J Salomon; Anna L David; Andrew Melbourne Journal: Prenat Diagn Date: 2019-07-28 Impact factor: 3.050