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- Title
Prediction of stillbirth from maternal factors, fetal biometry and uterine artery Doppler at 19-24 weeks.
- Authors
TOKUNAKA, M.; ORTEGA, N.; SYNGELAKI, A.; NICOLAIDES, K. H.; AKOLEKAR, R.
- Abstract
<bold>Objectives: </bold>To evaluate the performance of screening for all stillbirths and those due to impaired placentation and unexplained or other causes using a combination of maternal factors, fetal biometry and uterine artery pulsatility index (UtA-PI) at 19-24 weeks' gestation and to compare this performance with that of screening by UtA-PI alone.<bold>Methods: </bold>This was a prospective screening study of 70 003 singleton pregnancies including 69 735 live births and 268 (0.38%) antepartum stillbirths; 159 (59%) were secondary to impaired placentation and 109 (41%) were due to other or unexplained causes. Multivariable logistic regression analysis was used to develop a model for prediction of stillbirth based on a combination of maternal factors, fetal biometry and UtA-PI.<bold>Results: </bold>Combined screening predicted 55% of all stillbirths, including 75% of those due to impaired placentation and 23% of those that were unexplained or due to other causes, at a false-positive rate of 10%. Within the impaired placentation group, the detection rate of stillbirth < 32 weeks' gestation was higher than that of stillbirth ≥ 37 weeks (88% vs 46%; P < 0.001). The performance of screening by the combined test was superior to that of selecting the high-risk group on the basis of UtA-PI > 90th percentile for gestational age, which predicted 48% of all stillbirths, 70% of those due to impaired placentation and 15% of those that were unexplained or due to other causes.<bold>Conclusions: </bold>Second-trimester screening by a combination of UtA-PI with maternal factors and fetal biometry can predict a high proportion of stillbirths and, in particular, those that are due to impaired placentation. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
- Subjects
STILLBIRTH; BIOMETRY; UTERINE artery; PLACENTA abnormalities; PREDICTION models; MEDICAL screening; LOGISTIC regression analysis; MATHEMATICAL models; DIAGNOSIS; DOPPLER ultrasonography; ARTERIES; FETAL ultrasonic imaging; GESTATIONAL age; LONGITUDINAL method; PERINATAL death; PLACENTA; SECOND trimester of pregnancy; EARLY diagnosis
- Publication
Ultrasound in Obstetrics & Gynecology, 2016, Vol 48, p624
- ISSN
0960-7692
- Publication type
journal article
- DOI
10.1002/uog.17295