Objective
The objective of the study was to establish the diagnostic performance of ultrasound
screening for predicting late smallness for gestational age and/or fetal growth restriction.
Data Sources
A systematic search was performed to identify relevant studies published since 2007
in English, Spanish, French, Italian, or German, using the databases PubMed, ISI Web
of Science, and SCOPUS.
Study Eligibility Criteria
We used rrospective and retrospective cohort studies in low-risk or nonselected singleton
pregnancies with screening ultrasound performed at ≥32 weeks of gestation.
Study Appraisal and Synthesis Methods
The estimated fetal weight and fetal abdominal circumference were assessed as index
tests for the prediction of birthweight <10th (i.e. smallness for gestational age),
less than the fifth, and less than the third centile and fetal growth restriction
(estimated fetal weight less than the third or estimated fetal weight <10th plus Doppler
signs). Quality of the included studies was independently assessed by 2 reviewers,
using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. For the meta-analysis,
hierarchical summary receiver-operating characteristic curves were constructed, and
quantitative data synthesis was performed using random-effects models. The sensitivity
of the abdominal circumference <10th centile and estimated fetal weight <10th centile
for a fixed 10% false-positive rate was derived from the corresponding hierarchical
summary receiver-operating characteristic curves. Heterogeneity between studies was
visually assessed using Galbraith plots, and publication bias was assessed by funnel
plots and quantified by Deeks’ method.
Results
A total of 21 studies were included. Observed pooled sensitivities of abdominal circumference
and estimated fetal weight <10th centile for birthweight <10th centile were 35% (95%
confidence interval, 20–52%) and 38% (95% confidence interval, 31–46%), respectively.
Observed pooled specificities were 97% (95% confidence interval, 95–98%) and 95% (95%
confidence interval, 93–97%), respectively. Modeled sensitivities of abdominal circumference
and estimated fetal weight <10th centile for 10% false-positive rate were 78% (95%
confidence interval, 61–95%) and 54% (95% confidence interval, 46–52%), respectively.
The sensitivity of estimated fetal weight <10th centile was better when aimed to fetal
growth restriction than to smallness for gestational age. Meta-regression analysis
showed a significant increase in sensitivity when ultrasound evaluation was performed
later in pregnancy (P = .001).
Conclusion
Third-trimester abdominal circumference and estimated fetal weight perform similar
in predicting smallness for gestational age. However, for a fixed 10% false-positive
rate extrapolated sensitivity is higher for abdominal circumference. There is evidence
of better performance when the scan is performed near term and when fetal growth restriction
is the targeted condition.
Key words
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Article info
Publication history
Published online: January 09, 2019
Footnotes
The authors report no conflict of interest.
Identification
Copyright
© 2019 Published by Elsevier Inc.
