Detection of small for gestational age in preterm prelabor rupture of membranes by Hadlock versus the Fetal Medicine Foundation growth charts
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ObjectiveThe primary outcome was to compare the diagnostic accuracy of neonatal small for gestational age (SGA) by theHadlock and Fetal Medicine Foundation (FMF) charts in our cohort, followed by the ability to predict composite severeneonatal outcomes (SNO) in pregnancies with preterm prelabor rupture of membranes (PPROM). MethodsThis study was a secondary analysis of a prospective cohort of pregnancies with PPROM from 2015 to 2018, from23 to 36 completed weeks of gestation. Sensitivity, specificity, and positive and negative predictive values for theprimary and secondary outcomes of the Hadlock and FMF fetal charts were calculated. The discriminatory ability ofeach chart was compared using the area under the receiver’s operating curves of clinical characteristics. ResultsOf the 106 women who met the inclusion criteria, 48 (45%) were screened positive using the FMF fetal growth chartand 22 (21%) were screened positive using the Hadlock chart. SGA was diagnosed in 12 infants (11%). Both fetalgrowth charts had comparable diagnostic accuracies and were statistically significant predictors of SGA (Hadlock: areaunder the receiver operating characteristic curves [AUC], 0.76, risk ratio [RR], 7.6, 95% confidence interval [CI], 2.5-23;and FMF: AUC, 0.76 RR, 13.3 95%CI 1.8-99.3). Both growth standards were poor predictors of SNO. ConclusionThe Hadlock and FMF fetal growth charts have a similar accuracy to predict SGA in pregnancies complicated byPPROM. The FMF fetal growth chart may result in a 2-fold increase in positive screens, potentially increasing fetalsurveillance.
Abstract
ObjectiveThe primary outcome was to compare the diagnostic accuracy of neonatal small for gestational age (SGA) by theHadlock and Fetal Medicine Foundation (FMF) charts in our cohort, followed by the ability to predict composite severeneonatal outcomes (SNO) in pregnancies with preterm prelabor rupture of membranes (PPROM). MethodsThis study was a secondary analysis of a prospective cohort of pregnancies with PPROM from 2015 to 2018, from23 to 36 completed weeks of gestation. Sensitivity, specificity, and positive and negative predictive values for theprimary and secondary outcomes of the Hadlock and FMF fetal charts were calculated. The discriminatory ability ofeach chart was compared using the area under the receiver’s operating curves of clinical characteristics. ResultsOf the 106 women who met the inclusion criteria, 48 (45%) were screened positive using the FMF fetal growth chartand 22 (21%) were screened positive using the Hadlock chart. SGA was diagnosed in 12 infants (11%). Both fetalgrowth charts had comparable diagnostic accuracies and were statistically significant predictors of SGA (Hadlock: areaunder the receiver operating characteristic curves [AUC], 0.76, risk ratio [RR], 7.6, 95% confidence interval [CI], 2.5-23;and FMF: AUC, 0.76 RR, 13.3 95%CI 1.8-99.3). Both growth standards were poor predictors of SNO. ConclusionThe Hadlock and FMF fetal growth charts have a similar accuracy to predict SGA in pregnancies complicated byPPROM. The FMF fetal growth chart may result in a 2-fold increase in positive screens, potentially increasing fetalsurveillance.
참고문헌 (40)
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