Katherine L Grantz1, Ana M Ortega-Villa2, Sarah J Pugh1, Alaina Bever1, William Grobman3, Roger B Newman4, John Owen5, Deborah A Wing6,7, Paul S Albert8. 1. Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland. 2. Biostatistics Research Branch, Division Clinical Research, National Institute of Allergy and Infectious Diseases, Fishers Lane, Rockville, Maryland. 3. Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. 4. Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina. 5. Department of Obstetrics and Gynecology, The University of Alabama at Birmingham Center for Women's Reproductive Health, Birmingham, Alabama. 6. Department of Obstetrics-Gynecology, Division of Maternal-Fetal Medicine, University of California, Irvine, School of Medicine, Orange, California. 7. Miller Children's Hospital/Long Beach Memorial Medical Center, Long Beach, California. 8. Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland.
Abstract
OBJECTIVE: The objective of the study was to determine whether adding longitudinal measures of fundal height (FH) to the standard cross-sectional FH to trigger third trimester ultrasound estimated fetal weight (EFW) would improve small for gestational age (SGA) prediction. STUDY DESIGN: We developed a longitudinal FH calculator in a secondary analysis of a prospective cohort study of 1,939 nonobese pregnant women who underwent serial FH evaluations at 12 U.S. clinical sites. We evaluated cross-sectional FH measurement ≤ -3 cm at visit 3 (mean: 32.0 ± 1.6 weeks) versus the addition of longitudinal FH up to and including visit 3 to trigger an ultrasound to diagnose SGA defined as birthweight <10th percentile. If the FH cut points were not met, the SGA screen was classified as negative. If FH cut points were met and EFW was <10th percentile, the SGA screen was considered positive. If EFW was ≥10th percentile, the SGA screen was also considered negative. Sensitivity, specificity, and positive predictive value (PPV) and negative predictive value (NPV) were computed. RESULTS: In a comparison of methods, 5.8% of women were classified as at risk of SGA by both cross-sectional and longitudinal classification methods; cross-sectional FH identified an additional 4.0%, and longitudinal fundal height identified a separate, additional 4.5%.Using cross-sectional FH as an ultrasound trigger, EFW had a PPV and NPV for SGA of 69 and 92%, respectively. After adding longitudinal FH, PPV increased to 74%, whereas NPV of 92% remained unchanged; however, the number of women who underwent triggered EFW decreased from 9.7 to 5.7%. CONCLUSION: An innovative approach for calculating longitudinal FH to the standard cross-sectional FH improved identification of SGA birthweight, while simultaneously reducing the number of triggered ultrasounds. As an essentially free-of-charge screening test, our novel method has potential to decrease costs as well as perinatal morbidity and mortality (through better prediction of SGA). KEY POINTS: · We have developed an innovative calculator for fundal height trajectory.. · Longitudinal fundal height improves detection of SGA.. · As a low cost screening test, the fundal height calculator may decrease costs and morbidity through better prediction of SGA.. Thieme. All rights reserved.
OBJECTIVE: The objective of the study was to determine whether adding longitudinal measures of fundal height (FH) to the standard cross-sectional FH to trigger third trimester ultrasound estimated fetal weight (EFW) would improve small for gestational age (SGA) prediction. STUDY DESIGN: We developed a longitudinal FH calculator in a secondary analysis of a prospective cohort study of 1,939 nonobese pregnant women who underwent serial FH evaluations at 12 U.S. clinical sites. We evaluated cross-sectional FH measurement ≤ -3 cm at visit 3 (mean: 32.0 ± 1.6 weeks) versus the addition of longitudinal FH up to and including visit 3 to trigger an ultrasound to diagnose SGA defined as birthweight <10th percentile. If the FH cut points were not met, the SGA screen was classified as negative. If FH cut points were met and EFW was <10th percentile, the SGA screen was considered positive. If EFW was ≥10th percentile, the SGA screen was also considered negative. Sensitivity, specificity, and positive predictive value (PPV) and negative predictive value (NPV) were computed. RESULTS: In a comparison of methods, 5.8% of women were classified as at risk of SGA by both cross-sectional and longitudinal classification methods; cross-sectional FH identified an additional 4.0%, and longitudinal fundal height identified a separate, additional 4.5%.Using cross-sectional FH as an ultrasound trigger, EFW had a PPV and NPV for SGA of 69 and 92%, respectively. After adding longitudinal FH, PPV increased to 74%, whereas NPV of 92% remained unchanged; however, the number of women who underwent triggered EFW decreased from 9.7 to 5.7%. CONCLUSION: An innovative approach for calculating longitudinal FH to the standard cross-sectional FH improved identification of SGA birthweight, while simultaneously reducing the number of triggered ultrasounds. As an essentially free-of-charge screening test, our novel method has potential to decrease costs as well as perinatal morbidity and mortality (through better prediction of SGA). KEY POINTS: · We have developed an innovative calculator for fundal height trajectory.. · Longitudinal fundal height improves detection of SGA.. · As a low cost screening test, the fundal height calculator may decrease costs and morbidity through better prediction of SGA.. Thieme. All rights reserved.
Authors: Suneet P Chauhan; Hind Beydoun; Eugene Chang; Adam T Sandlin; Josh D Dahlke; Elena Igwe; Everett F Magann; Kristi R Anderson; Alfred Z Abuhamad; Cande V Ananth Journal: Am J Perinatol Date: 2013-04-16 Impact factor: 1.862
Authors: Jagteshwar Grewal; Katherine L Grantz; Cuilin Zhang; Anthony Sciscione; Deborah A Wing; William A Grobman; Roger B Newman; Ronald Wapner; Mary E D'Alton; Daniel Skupski; Michael P Nageotte; Angela C Ranzini; John Owen; Edward K Chien; Sabrina Craigo; Paul S Albert; Sungduk Kim; Mary L Hediger; Germaine M Buck Louis Journal: Int J Epidemiol Date: 2018-02-01 Impact factor: 7.196
Authors: Germaine M Buck Louis; Jagteshwar Grewal; Paul S Albert; Anthony Sciscione; Deborah A Wing; William A Grobman; Roger B Newman; Ronald Wapner; Mary E D'Alton; Daniel Skupski; Michael P Nageotte; Angela C Ranzini; John Owen; Edward K Chien; Sabrina Craigo; Mary L Hediger; Sungduk Kim; Cuilin Zhang; Katherine L Grantz Journal: Am J Obstet Gynecol Date: 2015-10 Impact factor: 8.661