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- Title
Severe smallness as predictor of adverse perinatal outcome in suspected late small-for-gestational-age fetuses: systematic review and meta-analysis.
- Authors
Meler, E.; Martinez‐Portilla, R. J.; Caradeux, J.; Mazarico, E.; Gil‐Armas, C.; Boada, D.; Martinez, J.; Carrillo, P.; Camacho, M.; Figueras, F.; Martinez-Portilla, R J; Gil-Armas, C
- Abstract
<bold>Objective: </bold>To investigate the performance of severe smallness in the prediction of adverse perinatal outcome among fetuses with suspected late-onset small-for-gestational age (SGA).<bold>Methods: </bold>A systematic search was performed to identify relevant studies in PubMed, Web of Science and Scopus. Late-onset SGA was defined as estimated fetal weight (EFW) or abdominal circumference (AC) < 10th percentile diagnosed at or after 32 weeks' gestation, while severe SGA was defined as EFW or AC < 3rd percentile or < 2 SD. Random-effects modeling was used to generate hierarchical summary receiver-operating-characteristics (HSROC) curves. The performance of severe SGA (as a presumptive diagnosis) in predicting adverse perinatal outcome among singleton pregnancies with suspected late-onset SGA was expressed as area under the HSROC curve (AUC), sensitivity, specificity and positive/negative likelihood ratios. The association between suspected severe SGA and adverse perinatal outcome was also assessed by random-effects modeling using the Mantel-Haenszel method and presented as odds ratio (OR). The non-exposed group was defined as non-severe SGA (EFW ≥ 3rd centile).<bold>Results: </bold>Twelve cohort studies were included in this systematic review and meta-analysis. The studies included a total of 3639 fetuses with suspected late-onset SGA, of which 1246 had suspected severe SGA. Significant associations were found between suspected severe SGA and composite adverse perinatal outcome (OR, 1.97 (95% CI, 1.33-2.92)), neonatal intensive care unit admission (OR, 2.87 (95% CI, 1.84-4.47)) and perinatal death (OR, 4.26 (95% CI, 1.07-16.93)). However, summary ROC curves showed limited performance of suspected severe SGA in predicting perinatal outcomes, with AUCs of 60.9%, 66.9%, 53.6%, 57.2%, 54.6% and 64.9% for composite adverse perinatal outcome, neonatal intensive care unit admission, neonatal acidosis, Cesarean section for intrapartum fetal compromise, low Apgar score and perinatal death, respectively.<bold>Conclusion: </bold>Although suspected severe SGA was associated with a higher risk of perinatal complications, it performed poorly as a standalone parameter in predicting adverse perinatal outcome. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
- Subjects
NEONATAL intensive care units; SMALL for gestational age; PERINATAL death; FETUS; CESAREAN section; FETAL distress; PREDICTIVE tests; FETAL growth retardation; BODY weight; FETAL ultrasonic imaging; META-analysis; SYSTEMATIC reviews; GESTATIONAL age; APGAR score; FETAL development
- Publication
Ultrasound in Obstetrics & Gynecology, 2022, Vol 60, Issue 3, p328
- ISSN
0960-7692
- Publication type
journal article
- DOI
10.1002/uog.24977