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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (1): 70-74    DOI: 10.31083/j.ceog.2020.01.5029
Original Research Previous articles | Next articles
Second trimester prediction of small for gestational age and intrauterine growth restriction
A.P. Londero1, S. Visentin2, L. Marin2, M. C. Bongiorno2, D. Visentin1, S. Bertozzi3, E. Cosmi2, A Cagnacci1, L. Driul1, *()
1Clinic of Obstetrics and Gynecology, DAME, ASUI "S. M. della Misericordia", Udine, Italy
2Department of Woman's and Child's Health, University of Padua, Padua, Italy
3Department of Surgery, DAME, ASUI "S M della Misericordia", Udine, Italy
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Abstract  

Aim: To analyze second trimester risk factors to predict small for gestational age and intrauterine growth restriction (IUGR) fetuses. Materials and Methods: The authors retrospectively analyzed clinical files of 5,390 women, who delivered between 2007 and 2009, 4,071 of which were included in the study. Adequate for gestational age (AGA), small for gestational age (SGA), and IUGR fetuses were included. Results: The authors found IUGR to be delivered significantly earlier than SGA and AGA. Moreover, they found a higher prevalence of nulliparity in SGA and IUGR fetuses than in AGA, and a significant higher prevalence of bilateral notch in SGA than AGA. SGA fetuses at 20 gestational weeks present a significantly higher value of umbilical artery pulsatility index (PI) and mean uterine arteries resistance index (RI) than AGA. In multivariate logistic regression analysis, the second trimester factors to predict SGA at delivery were: mother age, nulliparity, academic title, umbilical artery PI at 20 gestational weeks, mean RI of uterine arteries, and bilateral notch. In case of IUGR the most predictive factors were: mother age, nulliparity, and bilateral notch at 20 gestational weeks. Conclusions: Clinical interview and sonographic examination at 20 gestational weeks were capable to predict fetal growth potential.

Key words:  SGA prediction      Umbilical artery pulsatility index      Maternal-fetal Doppler      Second trimester ultrasound     
Published:  15 February 2020     
*Corresponding Author(s):  L. Driul     E-mail:  lorenza.drive@uniud.it

Cite this article: 

A.P. Londero, S. Visentin, L. Marin, M. C. Bongiorno, D. Visentin, S. Bertozzi, E. Cosmi, A Cagnacci, L. Driul. Second trimester prediction of small for gestational age and intrauterine growth restriction. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(1): 70-74.

URL: 

https://ceog.imrpress.com/EN/10.31083/j.ceog.2020.01.5029     OR     https://ceog.imrpress.com/EN/Y2020/V47/I1/70

Figure 1.  — Receiver operating characteristic (ROC) curve of the multivariate prediction model for SGA; AUC is 64% (CI.95 60-68%).

Figure 2.  — Receiver operating characteristic (ROC) curve of the multivariate prediction model for IUGR; AUC is 72% (CI 95 58-87%).

Table 1  — Description of the population.
AGA (3913) IUGR (13) SGA (145) p
Maternal age at delivery (years) 31.92 (±5.48) 33.77 (±6.04) 31.32 (±6.22) NS
Nulliparity 53.00% (2074/3913) 84.62% (11/13) 68.28% (99/145) 1, 2
Sub-Saharan-African origin 4.02% (157/3902) 0.00% (0/13) 10.34% (15/145) 2
Neonatal weight (grams) 3259.30 (±514.02) 1284.69 (±670.07) 2546.76 (±427.32) 1, 2, 3
Neonatal weight MoMs 1.01 (±0.08) 0.73 (±0.14) 0.78 (±0.08) 1, 2
Placental weight (grams) 584.30 (±111.68) 276.92 (±118.11) 479.70 (±96.69) 1, 2, 3
Placental index 0.18 (±0.04) 0.22 (±0.04) 0.19 (±0.05) 1, 2, 3
Apgar score 1st minute 8.10 (±1.27) 5.85 (±1.68) 7.87 (±1.41) 1, 3
Apgar score 5th minute 8.87 (±0.81) 7.46 (±0.97) 8.79 (±1.05) 1, 3
Gestational age at delivery (weeks) 38.67 (±2.38) 31.54 (±3.78) 38.57 (±1.73) 1, 3
PI umbilical artery (20 weeks) 1.19 (±0.19) 1.38 (±0.42) 1.26 (±0.21) 2
Mean RI uterine arteries (20 weeks) 0.55 (±0.09) 0.69 (±0.28) 0.59 (±0.11) 2
Bilateral notch (20 weeks) 2.25% (88/3913) 7.69% (1/13) 7.59% (11/145) 2
Table 2  — Multivariate logistic regression analysis: dependent variable SGA.
OR (IC95%) p
Maternal age at delivery 1.01 (0.99-1.04) 0.328
Nulliparity 1.97 (1.44-2.69) <0.05
University degree 0.74 (0.54-1.01) 0.062
PI umbilical artery (20 weeks) 2.81 (1.33-5.94) <0.05
Mean RI uterine arteries (20 weeks) 10.58 (2.29-48.91) <0.05
Bilateral notch (20 weeks) 1.72 (0.99-2.99) 0.054
Table 3  — Multivariate logistic regression analysis: dependent variable IUGR.
OR (IC95%) p
Maternal age at delivery 1.1 (0.99-1.22) 0.072
Nulliparity 5.88 (1.28-26.93) <0.05
Bilateral notch (20 weeks) 3.66 (0.46-28.91) 0.219
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