Reference
Reference
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Patients/Events
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Study Objective(Purpose of Study)
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Study Results
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1. Zhang J, Merialdi M, Platt LD, Kramer MS. Defining normal and abnormal fetal growth: promises and challenges. Am J Obstet Gynecol. 2010;202(6):522-528. Review/Other-Dx N/A A review to summarize the literature on the definition of abnormal fetal growth that goes beyond simple fetal size. No results stated in abstract. 4
2. Simon NV, Surosky BA, Shearer DM, Levisky JS. Effect of the pretest probability of intrauterine growth retardation on the predictiveness of sonographic estimated fetal weight in detecting IUGR: a clinical application of Bayes' theorem. J Clin Ultrasound. 1990;18(3):145-153. Observational-Dx 405 patients To assess if the effect of the pretest probability on the predictiveness of estimated fetal weight (EFW) through the use of Bayed theorem was supported by actual patient data, and to what extent a Bayesian approach to the interpretation of fetal weight estimates could affect clinical decision making in pregnancies at risk for fetal growth retardation. The positive predictive value of the test, as well as the probability of having a growth-retarded infant after a normal EFW was obtained were considerably higher when the pretest probability of IUGR increased. In the very low risk group, the probability of severe IUGR was negligible regardless of the EFW. When the EFW was less than 10th percentile of our age-dependent EFW curve, the probability of severe IUGR in the other risk groups was high enough to warrant fetal well-being surveillance and/or timely interruption of gestation as appropriate. However, when the pretest probability was high, the risk of severe IUGR in spite of an EFW within the 10th percentile to 90th percentile remained sufficient to require fetal well-being surveillance as well. 4
3. Skovron ML, Berkowitz GS, Lapinski RH, Kim JM, Chitkara U. Evaluation of early third-trimester ultrasound screening for intrauterine growth retardation. J Ultrasound Med. 1991;10(3):153-159. Observational-Dx 69 of 768 infants were IUGR at birth A comparative study to asssess the US fetal biometry to detect IUGR using ROC curve analysis of data at 26-34 weeks Estimated fetal weight and abdominal circumference were equivalently better than femur length/abdominal circumference at predicting IUGR. 3
4. Dashe JS, McIntire DD, Lucas MJ, Leveno KJ. Effects of symmetric and asymmetric fetal growth on pregnancy outcomes. Obstet Gynecol. 2000;96(3):321-327. Review/Other-Dx 33,740 nonanomalous live-born singletons To assess the prevalence of head circumference to abdomen circumference (HC/AC) asymmetry among small for gestational age (SGA) fetuses, and to determine the likelihood of adverse outcomes among asymmetric and symmetric SGA infants compared with their appropriate for gestational age (AGA) counterparts. Biometry done at 26-34 weeks was less predictive than when done within 2 weeks of delivery. 4
5. A randomised trial of timed delivery for the compromised preterm fetus: short term outcomes and Bayesian interpretation. Bjog. 2003;110(1):27-32. Experimental-Dx 547 mothers; 587 babies To compare the effect of delivering early to pre-empt terminal hypoxaemia with delaying for as long as possible to increase maturity. Of 548 women (588 babies) recruited, outcomes were available on 547 mothers (587 babies). The median time-to-delivery intervals were 0.9 days in the immediate group and 4.9 days in the delay group. Total deaths prior to discharge were 29 (10%) in the immediate group versus 27 (9%) in the delay group (odds ratio 1.1, 95% CI 0.61-1.8). Total caesarean sections were 249 (91%) in the immediate group versus 217 (79%) in the delay group: (OR 2.7; 95% CI 1.6-4.5). These odds ratios were similar for those randomized at gestational ages above or below 30 weeks. 1
6. Thornton JG, Hornbuckle J, Vail A, Spiegelhalter DJ, Levene M. Infant wellbeing at 2 years of age in the Growth Restriction Intervention Trial (GRIT): multicentred randomised controlled trial. Lancet. 2004;364(9433):513-520. Experimental-Dx 548 pregnant women To compare the effect of delivering early with delaying birth among pregnant women. Primary outcomes were available on 290 (98%) immediate and 283 (97%) deferred deliveries. Overall rate of death or severe disability at 2 years was 55 (19%) of 290 immediate births, and 44 (16%) of 283 delayed births. With adjustment for gestational age and umbilical-artery doppler category, the odds ratio (95% CrI) was 1.1 (0.7-1.8). Most of the observed difference was in disability in babies younger than 31 weeks of gestation at randomisation: 14 (13%) immediate versus five (5%) delayed deliveries. No important differences in the median Griffiths developmental quotient in survivors was seen. 1
7. Manning FA. The use of sonography in the evaluation of the high-risk pregnancy. Radiol Clin North Am. 1990;28(1):205-216 Review/Other-Dx N/A To review the role of dynamic ultrasound fetal assessment and fetal biophysical profile scoring in the recognition and management of the high-risk pregnancy. No results stated in abstract. 4
8. Tongsong T, Srisomboon J. Amniotic fluid volume as a predictor of fetal distress in intrauterine growth retardation. Int J Gynaecol Obstet. 1993;40(2):131-134. Observational-Dx 242 pregnancies with IUGR To determine the efficacy of sonographic assessment of amniotic fluid volume (AFV) in predicting intrapartum fetal distress in pregnancies with intrauterine growth retardation (IUGR) compared with the nonstress test (NST). AFV was a reliable predictor of intrapartum fetal distress with sensitivity, specificity, positive and negative predictive values of 84.0%, 83.41%, 36.84% and 97.84%, respectively. The efficacy of AFV was comparable with that of the NST. 3
9. Cosmi E, Ambrosini G, D'Antona D, Saccardi C, Mari G. Doppler, cardiotocography, and biophysical profile changes in growth-restricted fetuses. Obstet Gynecol. 2005;106(6):1240-1245. Observational-Dx 145 singleton growth-restricted fetuses To assess from diagnosis to delivery the Doppler studies of the umbilical artery, middle cerebral artery, umbilical vein, ductus venosus, and amniotic fluid index of fetuses with idiopathic growth restriction. There were 4 fetal and 50 neonatal deaths. Two growth-restricted groups were identified: Group A (n = 44) included fetuses in whom all measures became abnormal preceding an abnormal biophysical profile or nonreassuring nonstress test. Group B (n = 101) included fetuses in whom 1 or more measures were normal at the time of cesarean delivery. There was no statistically significant difference in perinatal morbidity and mortality between the 2 groups. Neonatal death was increased in fetuses with umbilical artery reversed flow (odds ratio 2.34, 95% confidence interval 1.16-4.73; P < .05) and ductus venosus reversed flow (odds ratio 4.18, 95% confidence interval 2.01-8.69; P < .05). A significant correlation was also found between low birth weight and adverse perinatal outcome. 3
10. Bewley S, Cooper D, Campbell S. Doppler investigation of uteroplacental blood flow resistance in the second trimester: a screening study for pre-eclampsia and intrauterine growth retardation. Br J Obstet Gynaecol. 1991;98(9):871-879. Observational-Dx 977 women To assess the screening properties of a mid-trimester uteroplacental Doppler scan in a normal unselected population. There was a 96.5% follow-up. Pregnancies with high AVRI values had a higher prevalence of proteinuric hypertension, placental abruption, small-for-gestational-age babies, and fetal loss. When AVRI was greater than 95th centile, the overall risk of pregnancy complications was 67%, and the risk of a severe complication was 25%. However, the sensitivity of the test for these complications was only 13% and 21% respectively. The risk for an individual woman with a high AVRI of developing a complication was increased by up to 9.8 times. 3
11. Newnham JP, Patterson LL, James IR, Diepeveen DA, Reid SE. An evaluation of the efficacy of Doppler flow velocity waveform analysis as a screening test in pregnancy. Am J Obstet Gynecol. 1990;162(2):403-410. Observational-Dx 535 medium-risk pregnancies Prospective double-blind study to evaluate the efficacy of uterine and umbilical Doppler waveform analysis as a screening test for development of fetal hypoxia and IUGR. Uteroplacental systolic to diastolic ratios at 24 weeks was associated with subsequent fetal hypoxia. Sensitivity 24%, specificity 94%, 70% of abnormal tests did not have fetal hypoxia. UA systolic to diastolic ratio at 24-34 weeks was predictive of IUGR, but only weakly if no hypoxia. Favors role for uteroplacental and UA Doppler in high-risk pregnancies, but not as a primary screening test for low risk pregnancies. 3
12. Alfirevic Z, Neilson JP. Doppler ultrasonography in high-risk pregnancies: systematic review with meta-analysis. Am J Obstet Gynecol. 1995;172(5):1379-1387. Meta-analysis 12 randomized controlled trials To review all available (published and unpublished) randomized controlled trials of Doppler ultrasonography of the umbilical artery in high-risk pregnancies. Meta-analysis shows a significant reduction in the number of antenatal admissions (44%, 95% confidence interval 28% to 57%), inductions of labor (20%, 95% confidence interval 10% to 28%), and cesarean sections for fetal distress (52%, 95% confidence interval 24% to 69%) in the Doppler group and that the clinical action guided by Doppler ultrasonography reduces the odds of perinatal death by 38% (95% confidence interval 15% to 55%). The reduction in perinatal deaths was also observed in five mortality subgroups (i.e., stillbirths, neonatal deaths, deaths of normally formed babies, normally formed stillbirths, and deaths of normally formed neonates). Post hoc analyses revealed a statistically significant reduction in elective delivery, intrapartum fetal distress, and hypoxic encephalopathy in the Doppler group. M
13. Benson CB, Belville JS, Lentini JF, Saltzman DH, Doubilet PM. Intrauterine growth retardation: diagnosis based on multiple parameters--a prospective study. Radiology. 1990;177(2):499-502. Observational-Dx 356 third-trimester fetuses To prospectively test the ability of the IUGR score to diagnose or exclude IUGR prenatally The IUGR score performed best in patients with accurate dating by early ultrasound (US), but even among patients lacking accurate dating, the performance of the IUGR score was superior to that previously reported for any single sonographic parameter. The IUGR score can be used in any US facility to diagnose or exclude third-trimester IUGR. 3
14. Ferrazzi E, Vegni C, Bellotti M, Borboni A, Della Peruta S, Barbera A. Role of umbilical Doppler velocimetry in the biophysical assessment of the growth-retarded fetus. Answers from neonatal morbidity and mortality. J Ultrasound Med. 1991;10(6):309-315 Review/Other-Dx 85 pregnancies To compare umbilical Doppler velocimetry with biophysical parameters, obstetrical management, and neonatal morbidity. The prevalence of neonatal morbidity was significantly higher in fetuses with associated abnormal umbilical pulsatility index (PI) in utero. Newborns with abnormal PI were delivered earlier, mostly for fetal indication, and were smaller and more asymmetrical than newborns with a normal PI in utero. The analysis of morbidity for homogeneous classes of weight showed that in the group of newborns between 1500 and 2500 g, newborns with normal umbilical PI did show only metabolic disturbances and one respiratory distress syndrome. On the contrary, newborns of the same gestational age and of the same weight with abnormal PI had more severe morbid episodes. In the class of weight between 1500 and 1000 g not only the severity but also the prevalence of neonatal morbidity was significantly higher in newborns with an abnormal PI in utero. None of the newborns delivered below 1000 g had a normal umbilical PI. Five died in the early neonatal period. Three suffered from mild neuromotor sequelae. 4
15. Lombardi SJ, Rosemond R, Ball R, Entman SS, Boehm FH. Umbilical artery velocimetry as a predictor of adverse outcome in pregnancies complicated by oligohydramnios. Obstet Gynecol. 1989;74(3 Pt 1):338-341. Observational-Dx 22 women A prospective study to establish the predictive value of Doppler velocimetry in identifying the fetus with oligohydramnios at increased risk of adverse perinatal outcome. Perinatal morbidity occurred in 100% in this group. An abnormal umbilical artery waveform may provide confirmatory evidence of impending fetal compromise when the antenatal sonographic diagnosis of oligohydramnios is made. 3
16. Rochelson B, Bracero LA, Porte J, Farmakides G. Diagnosis of intrauterine growth retardation as a two-step process with morphometric ultrasound and Doppler umbilical artery velocimetry. J Reprod Med. 1992;37(11):925-929. Observational-Dx 40 women To assess the serial use of ultrasound and Doppler umbilical artery velocimetry to diagnose the small-for-gestational-age (SGA) fetus. Diagnostic accuracy was improved from 65% by ultrasonography alone to 92% by the addition of an abnormal umbilical artery waveform (P < .02). An abnormal waveform was associated with an adverse outcome in 62%, compared to 14% with normal velocimetry (P < .01). The majority of small fetuses have a normal outcome. 3
17. Tyrrell SN, Lilford RJ, Macdonald HN, Nelson EJ, Porter J, Gupta JK. Randomized comparison of routine vs highly selective use of Doppler ultrasound and biophysical scoring to investigate high risk pregnancies. Br J Obstet Gynaecol. 1990; 97(10):909-916. Experimental-Dx 500 pregnant women To compare routine versus highly selective use of Doppler ultrasound and biophysical scoring in higher risk pregnancy. Risk factors were distributed very evenly between the 250 patients in the study and control groups respectively. A total of 902 biophysical profile and Doppler assessments were done in the 250 study group patients and only in 12 patients in the control group. In the study group, absent end-diastolic flow was found in only 2.7% of all 902 measurements. A persistently abnormal biophysical score was always associated with absence of end-diastolic flow. The mean gestational age at induction of labour was statistically and clinically similar in the two groups and there was no overall statistically significant difference in intervention rates between the two groups. There was a statistically significant lower frequency of depressed 5-min Apgar scores in the study group. Serious neonatal morbidity was also statistically significantly more common in the control group than in the study group. 1
18. James DK, Parker MJ, Smoleniec JS. Comprehensive fetal assessment with three ultrasonographic characteristics. Am J Obstet Gynecol. 1992;166(5):1486-1495. Review/Other-Dx 103 fetuses (100 mothers) To review the order and time scale for development of abnormalities of UA Doppler, abdominal circumference, BPP, and the short term outcome with abnormalities of these parameters in fetuses at risk of chronic asphyxia. The order of deterioration (which had a very variable time scale) was umbilical artery Doppler recording, followed by abdominal circumference and finally biophysical profile score. Normal characteristics or an abnormal umbilical artery Doppler recording alone or an abnormal abdominal circumference alone was associated with an excellent prognosis. The worst outcome was found in the 28 fetuses with abnormality of all three ultrasonographic features before delivery. 4
19. Morris JM, Trudinger BJ. Sonographic evaluation of intrauterine growth retardation. Curr Opin Radiol. 1992;4(2):102-110. Review/Other-Dx N/A A review to discuss the role of ultrasound biometry in establishing whether a fetus is small. No results stated in abstract. 4
20. Dubinsky T, Lau M, Powell F, et al. Predicting poor neonatal outcome: a comparative study of noninvasive antenatal testing methods. AJR Am J Roentgenol. 1997;168(3):827-831. Observational-Dx 97 cases To compare amniotic fluid indexes, umbilical cord arterial Doppler waveforms, nonstress tests, and biophysical profiles for predicting poor neonatal outcomes in fetuses who are small for gestational age (SGA). Of the 30 fetuses who had poor outcomes, five were emergency cesarean deliveries, three died, three had intracranial hemorrhages, one had a cerebral infarct, 12 had prolonged admission to the neonatal intensive care unit (NICU) (> 10 days), and six had NICU admissions at term. Of the variables we assessed, the sensitivities for predicting poor outcome were as follows: cord Doppler imaging, 64%; low amniotic fluid volume (oligohydramnios), 32%; biophysical profile, 18%; and nonstress test, 14%. Receiver operating characteristic curves showed that a systolic:diastolic ratio of 4.0 and an amniotic fluid index of 5 cm (independent of gestational age) were the most accurate cutoff values for predicting poor outcome. Logistic regression analysis showed that amniotic fluid indexes and umbilical cord arterial Doppler imaging were independent predictors of poor outcome and that the predictive value of the biophysical profile varied according to the amniotic fluid index. 3
21. Ott WJ. Intrauterine growth restriction and Doppler ultrasonography. J Ultrasound Med. 2000;19(10):661-665; quiz 667. Observational-Dx 578 patients A retrospective study to clarify the difference between the fetus that is small for gestational age and the fetus with true intrauterine growth restriction. The small for gestational age fetuses with normal Doppler studies showed no increased morbidity when compared with their average for gestational age cohorts. Umbilical artery Doppler blood flow studies were a better predictor of neonatal outcome than estimated fetal weight. Small for gestational age fetuses with normal Doppler studies most likely represent constitutionally small, not pathologically growth restricted, fetuses. 4
22. Rizzo G, Capponi A, Talone PE, Arduini D, Romanini C. Doppler indices from inferior vena cava and ductus venosus in predicting pH and oxygen tension in umbilical blood at cordocentesis in growth-retarded fetuses. Ultrasound Obstet Gynecol. 1996;7(6):401-410. Observational-Dx 209 normally grown fetuses; 89 growth-retarded fetuses. To assess the value of Doppler indices calculated from the inferior vena cava and ductus venosus in the identification of acidemia and hypoxemia as determined by pH and gas analysis of fetal blood obtained by cordocentesis in growth-retarded fetuses. Logistic regression and receiver operator characteristic curve analysis were performed to examine the relationship between Doppler indices and acid-base status. The pre-load index (peak velocity during atrial contraction/peak velocity during systole) in the inferior vena cava was the best explanatory variable for acidemia (chi 2 = 48.33; p < or = 0.001). Hypoxemia was predicted less well by venous indices and the best results were achieved by the S/A ratio in the ductus venosus (chi 2 = 9.46; p < or = 0.005). 3
23. Baschat AA, Cosmi E, Bilardo CM, et al. Predictors of neonatal outcome in early-onset placental dysfunction. Obstet Gynecol. 2007;109(2 Pt 1):253-261. Observational-Dx 604 patients To identify specific estimates and predictors of neonatal morbidity and mortality in early onset fetal growth restriction due to placental dysfunction. Major morbidity occurred in 35.9% of 604 neonates: bronchopulmonary dysplasia in 23.2% (n=140), intraventricular hemorrhage in 15.2% (n=92), and necrotizing enterocolitis in 12.4% (n=75). Total mortality was 21.5 % (n=130), and 58.3% survived without complication (n=352). From 24 to 32 weeks, major morbidity declined (56.6% to 10.5%), coinciding with survival that exceeded 50% after 26 weeks. Gestational age was the most significant determinant (P<.005) of total survival until 26(6/7) weeks (r(2)=0.27), and intact survival until 29(2/7) weeks (r(2)=0.42). Beyond these gestational-age cutoffs, and above birth weight of 600 g, ductus venosus Doppler and cord artery pH predicted neonatal mortality (P<.001, r(2)=0.38), and ductus venosus Doppler alone predicted intact survival (P<.001, r(2)=0.34). 3
24. Snijders RJ, Sherrod C, Gosden CM, Nicolaides KH. Fetal growth retardation: associated malformations and chromosomal abnormalities. Am J Obstet Gynecol. 1993;168(2):547-555 Review/Other-Dx 458 fetuses To determine the incidence and pattern of chromosomal abnormalities in fetal growth retardation. The fetal karyotype was normal in 369 and abnormal in 89 (19%) of the cases. The most common chromosomal defect in the group referred at < 26 weeks' gestation was triploidy; in those referred at > or = 26 weeks, it was trisomy 18. The incidence of fetal autosomal chromosome aberrations increased, whereas the incidence of triploidy did not change, with maternal age. Ninety-six percent of chromosomally abnormal fetuses had multisystem fetal defects that were characteristic of the different types of chromosomal abnormalities. Compared with those fetuses with a normal karyotype, the chromosomally abnormal group had a higher mean head circumference/abdominal circumference ratio, a higher incidence of normal or increased amniotic fluid volume, and normal waveforms from the uterine or umbilical arteries or both. 4