Reduced fetal growth velocity leads to fetal death?
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A study was conducted to determine whether decreased fetal growth velocity precedes antepartum fetal death, and also to evaluate if fetal growth velocity predicts better antepartum fetal death compared to a single, last available, ultrasound examination prior to diagnosis.

Researchers conducted a retrospective, longitudinal study of 4,285 singleton pregnancies in African-American women who underwent at least two fetal ultrasound examinations between 14 and 32 weeks of gestation and delivered a live born neonate or experienced antepartum fetal death. Fetal death was defined as the death of a fetus 20 weeks of gestation and confirmed by ultrasound examination. The ultrasound examination performed at the time of fetal demise was not included in the analysis. Growth percentiles for the estimated fetal weight (EFW) and individual biometric parameters were determined. Fetal growth percentile velocity was defined as the slope of the regression line of the growth percentiles as a function of gestational age based on two or more measurements in each pregnancy.

1) Cases had significantly lower EFW and fetal head circumference (HC), biparietal diameter, abdominal circumference, and femur length percentile velocities compared to controls.

2) Fetuses with EFW percentile velocity <10th percentile among controls had 9.4 fold and 11.2 fold increased risk to die antepartum based on Hadlock and customized PRB/NICHD standards, respectively;

3) at a 10% false-positive rate, the sensitivity for antepartum fetal death of the EFW percentile velocity was 57%, compared to 26% for a single, last available, examination.

Given that 74% of antepartum fetal death cases were not small for gestational age at the last ultrasound examination when they were alive, alternative approaches are needed to improve the detection of fetuses at risk for fetal death. Longitudinal sonographic evaluations to determine growth velocity doubles the sensitivity for prediction of antepartum fetal death compared to a single ultrasound examination, yet performance is still sub-optimal.

Source: https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1002/uog.23111?af=R
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Dr. A●●●●●a P●●●l
Dr. A●●●●●a P●●●l Obstetrics and Gynaecology
But the Hadlock 1985 formula which considers HC, AC & FL as parameters to determine Exact EFW is accurate in predicting.. At what percentile of EFW the death rate is more..?
Sep 17, 2020Like