Prediction of small-for-gestational-age neonates: screening by uterine artery Doppler and mean arterial pressure at 30-34 weeks

ObjectiveTo investigate the potential value of uterine artery (UtA) pulsatility index (PI) and mean arterial pressure (MAP) at 30-34 weeks' gestation in the prediction of small-for-gestational-age (SGA) neonates, in the absence of pre-eclampsia (PE). MethodsThis was a screening study in singleton pregnancies at 30-34 weeks' gestation, including 1727 that delivered SGA neonates with a birth weight<5(th) percentile and 29122 that were unaffected by SGA, PE or gestational hypertension (normal group). Multivariable logistic regression analysis was used to determine if measuring the UtA-PI and MAP improved the prediction of SGA neonates provided by screening with maternal characteristics and medical history (maternal factors), and estimated fetal weight (EFW) calculated from fetal head circumference, abdominal circumference and femur length. ResultsCombined screening by maternal factors and EFWZ-scores predicted 79%, 87% and 92% of SGA neonates delivering<5weeks following assessment, with a birth weight<10(th), <5(th) and<3(rd) percentiles, respectively, at a false-positive rate of 10%. The addition of UtA-PI and MAP improved the respective detection rates to 83%, 91% and 93%. Screening by maternal factors and EFWZ-scores predicted 53%, 58% and 61% of SGA delivering5weeks following assessment and these rates increased to 53%, 60% and 63% with the addition of UtA-PI and MAP. ConclusionCombined testing by maternal factors, fetal biometry, UtA-PI and MAP at 30-34 weeks' gestation could identify a high proportion of pregnancies that deliver SGA neonates. Copyright (c) 2015 ISUOG. Published by John Wiley & Sons Ltd.