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Is prenatal identification of small-for-gestational-age fetuses useful?

Erdogan Nohuz, Olivier Rivière, Karen Coste, Françoise Vendittelli
Ultrasound in Obstetrics & Gynecology 2019 April 4

OBJECTIVE: To assess whether prenatal identification of small-for-gestational-age (SGA) fetuses would reduce the rates of the primary composite outcome of 'stillbirths and neonatal complications', and secondary outcomes of stillbirth and low 5-min Apgar score.

METHODS: This historical cohort study was conducted with women who had singleton delivery (≥ 32 weeks), in 247 French maternity units. Medical terminations of pregnancy, infants with malformations, and women with missing delivery data were excluded. Among the infants born SGA (<5th percentile), we compared those who had been identified as such in utero (i.e. "exposed group") (n=5,093) with those who had not (i.e. "non-exposed group") (n=19,853). The main endpoint was a composite variable defined as stillbirth or death in the delivery room, or transfer to a neonatal intensive care unit (NCIU). The secondary outcomes were stillbirth and 5-min Apgar score.

RESULTS: Mean birthweight in the cohort was 2449.1 ± 368.3 g. The adjusted Relative Risk (aRR) for the main composite outcome was 1.29 (95%CI: 1.21-1.38) in the group identified prenatally as SGA compared with non-identified SGA fetuses (39.5% vs. 13.5%). In the subgroups, i.e. ≥37-<40 weeks and ≥40 weeks, prenatal identification of SGA fetuses improved this main outcome. The stillbirth rate was reduced for fetuses with prenatal suspicion of SGA (aRR=0.47; 95%CI: 0.27-0.79). The 5-min. Apgar score did not differ between the 2 groups. The a posteriori study power with α=0.05 was 99%.

CONCLUSIONS: Among children born SGA, prenatal identification did not improve, globally, fetal and neonatal issues; however, it reduced stillbirth. This article is protected by copyright. All rights reserved.


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