Effectiveness of Risk Stratification for Fetal Growth Restriction at Routine Antenatal Ultrasound Assessment at 11-14 Gestation Weeks in a Rural Population of Western India.

Aim: To determine the effectiveness of risk stratification at the 11-14 weeks ultrasound assessment in identifying women at high risk for fetal growth restriction (FGR) in rural Western India.

Methods: Consecutively selected pregnant women were screened using ultrasound and fetal Doppler at 11-14 gestational weeks, and the risk for FGR was ascertained using the Fetal Medicine Foundation algorithm and a 1 in 150 cutoff. In the third trimester, FGR was defined as an estimated fetal weight (EFW) < 3rd percentile irrespective of fetal Doppler status or EFW 3rd to 10th percentile with abnormal fetal Doppler. Sensitivity, specificity, predictive values, odds ratio (OR) and area under receiver operator characteristic curve (AUC) were estimated for the risk stratification model.

Results: First-trimester screening identified 302 (48.78%) of 619 women at high risk for FGR. The incidence of FGR in the third trimester was 13.2% (n = 82) including 69 (22.8%) of 302 women at high risk and 13 (4.1%) of the 317 low-risk screened women. The first-trimester risk stratification had a sensitivity of 84.3%, a negative predictive value of 95.9%, an AUC of 0.71, and an OR of 7.06 for FGR in the third trimester.

Conclusion: First-trimester risk stratification of pregnant women using fetal ultrasound and Doppler was useful in predicting FGR in the third trimester.