{"title":"Reply.","authors":"A Deslandes, M Leonardi","doi":"10.1002/uog.29149","DOIUrl":"https://doi.org/10.1002/uog.29149","url":null,"abstract":"","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142732939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C Winsloe, J Elhindi, M C Vieira, S Relph, C G Arcus, K Coxon, A Briley, M Johnson, L M Page, A Shennan, N Marlow, C Lees, D A Lawlor, A Khalil, J Sandall, A Copas, D Pasupathy
{"title":"Perinatal outcomes after selective third-trimester ultrasound screening for small-for-gestational age: prospective cohort study nested within DESiGN randomized controlled trial.","authors":"C Winsloe, J Elhindi, M C Vieira, S Relph, C G Arcus, K Coxon, A Briley, M Johnson, L M Page, A Shennan, N Marlow, C Lees, D A Lawlor, A Khalil, J Sandall, A Copas, D Pasupathy","doi":"10.1002/uog.29130","DOIUrl":"https://doi.org/10.1002/uog.29130","url":null,"abstract":"<p><strong>Objective: </strong>In screening for small-for-gestational age (SGA) using third-trimester antenatal ultrasound, there are concerns about the low detection rates and potential for harm caused by both false-negative and false-positive screening results. Using a selective third-trimester ultrasound screening program, this study aimed to investigate the incidence of adverse perinatal outcomes among cases with (i) false-negative compared with true-positive SGA diagnosis and (ii) false-positive compared with true-negative SGA diagnosis.</p><p><strong>Methods: </strong>This prospective cohort study was nested within the UK-based DESiGN trial, a prospective multicenter cohort study of singleton pregnancies without antenatally detected fetal anomalies, born at > 24 + 0 to < 43 + 0 weeks' gestation. We included women recruited to the baseline period, or control arm, of the trial who were not exposed to the Growth Assessment Protocol (GAP) intervention and whose birth outcomes were known. Stillbirth and major neonatal morbidity were the two primary outcomes. Minor neonatal morbidity was considered a secondary outcome. Suspected SGA was defined as an estimated fetal weight (EFW) < 10<sup>th</sup> percentile, based on the Hadlock formula and fetal growth charts. Similarly, SGA at birth was defined as birth weight (BW) < 10<sup>th</sup> percentile, based on UK population references. Maternal and pregnancy characteristics and perinatal outcomes were reported according to whether SGA was suspected antenatally or not. Unadjusted and adjusted logistic regression models were used to quantify the differences in adverse perinatal outcomes between the screening results (false negative vs true positive and false positive vs true negative).</p><p><strong>Results: </strong>In total, 165 321 pregnancies were included in the analysis. Fetuses with a false-negative SGA screening result, compared to those with a true-positive result, were at a significantly higher risk of stillbirth (adjusted OR (aOR), 1.18 (95% CI, 1.07-1.31)), but at lower risk of major (aOR, 0.87 (95% CI, 0.83-0.91)) and minor (aOR, 0.56, (95% CI, 0.54-0.59)) neonatal morbidity. Compared with a true-negative screening result, a false-positive result was associated with a lower BW percentile (median, 18.1 (interquartile range (IQR), 13.3-26.9)) vs 49.9 (IQR, 30.3-71.7)). A false-positive result was also associated with a significantly increased risk of stillbirth (aOR, 2.24 (95% CI, 1.88-2.68)) and minor neonatal morbidity (aOR, 1.60 (95% CI, 1.51-1.71)), but not major neonatal morbidity (aOR, 1.04 (95% CI, 0.98-1.09)).</p><p><strong>Conclusions: </strong>In selective third-trimester ultrasound screening for SGA, both false-negative and false-positive results were associated with a significantly higher risk of stillbirth, when compared with true-positive and true-negative results, respectively. Improved SGA detection is needed to address false-negative results. It should be acknowledged that ca","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S Adjahou, A Syngelaki, M Nanda, D Papavasileiou, R Akolekar, K H Nicolaides
{"title":"Routine 36-week scan: prediction of small-for-gestational- age neonate.","authors":"S Adjahou, A Syngelaki, M Nanda, D Papavasileiou, R Akolekar, K H Nicolaides","doi":"10.1002/uog.29134","DOIUrl":"https://doi.org/10.1002/uog.29134","url":null,"abstract":"<p><strong>Objectives: </strong>First, to compare the predictive performance of routine ultrasonographic estimated fetal weight (EFW) at 31 + 0 to 33 + 6 and 35 + 0 to 36 + 6 weeks' gestation for delivery of a small-for-gestational-age (SGA) neonate. Second, to compare the predictive performance of EFW at 36 weeks' gestation for SGA vs fetal growth restriction (FGR) at birth. Third, to compare the predictive performance for delivery of a SGA neonate of EFW < 10<sup>th</sup> percentile vs a model combining maternal demographic characteristics and elements of medical history with EFW.</p><p><strong>Methods: </strong>This was a retrospective analysis of prospectively collected data in 21 676 women with a singleton pregnancy who had undergone routine ultrasound examination at 31 + 0 to 33 + 6 weeks' gestation and 107 875 women with a singleton pregnancy who had undergone routine ultrasound examination at 35 + 0 to 36 + 6 weeks. Measurements of fetal head circumference, abdominal circumference and femur length were used to calculate EFW according to the Hadlock formula and this was expressed as a percentile according to the Fetal Medicine Foundation fetal and neonatal population weight charts. The same charts were used to diagnose SGA neonates with birth weight < 10<sup>th</sup> or < 3<sup>rd</sup> percentile. FGR was defined as birth weight < 10<sup>th</sup> percentile in addition to Doppler anomalies. For each gestational-age window at screening, the screen-positive rate and detection rate were calculated at different EFW cut-offs between the 10<sup>th</sup> and 50<sup>th</sup> percentiles for predicting the delivery of a SGA neonate with birth weight < 10<sup>th</sup> or < 3<sup>rd</sup> percentile, either within 2 weeks or at any time after assessment. The areas under the receiver-operating-characteristics curves (AUC) of screening for a SGA neonate by EFW at 31 + 0 to 33 + 6 weeks and at 35 + 0 to 36 + 6 weeks were compared.</p><p><strong>Results: </strong>The predictive performance of routine ultrasonographic examination during the third trimester for delivery of a SGA neonate is higher if: first, the scan is carried out at 35 + 0 to 36 + 6 weeks' gestation rather than at 31 + 0 to 33 + 6 weeks; second, the outcome measure is birth weight < 3<sup>rd</sup> rather than < 10<sup>th</sup> percentile; third, the outcome measure is FGR rather than SGA; fourth, if delivery occurs within 2 weeks after assessment rather than at any time after assessment; and fifth, prediction is performed using a model that combines maternal demographic characteristics and elements of medical history with EFW rather than EFW < 10<sup>th</sup> percentile alone. At 35 + 0 to 36 + 6 weeks' gestation, detection of ≥ 85% of SGA neonates with birth weight < 10<sup>th</sup> percentile born at any time after assessment necessitates the use of EFW < 40<sup>th</sup> percentile. Screening at this percentile cut-off predicted 95% and 98% of neonates with birth weight < 10<sup>th</su","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Congenital heart defects during COVID-19 pandemic.","authors":"A Khalil, I Painter, V Souter","doi":"10.1002/uog.29126","DOIUrl":"10.1002/uog.29126","url":null,"abstract":"","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comprehensive prenatal ultrasound for surgical risk assessment: differentiating placenta accreta spectrum from uterine scar dehiscence for improved clinical decision-making.","authors":"R A Aryananda, T K Adu-Bredu","doi":"10.1002/uog.29138","DOIUrl":"https://doi.org/10.1002/uog.29138","url":null,"abstract":"","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}