Poor effectiveness of antenatal detection of fetal growth restriction and consequences for obstetric management and neonatal outcomes: a French national study

被引:137
作者
Monier, I. [1 ]
Blondel, B. [1 ]
Ego, A. [1 ,2 ]
Kaminiski, M. [1 ]
Goffinet, F. [1 ,3 ]
Zeitlin, J. [1 ]
机构
[1] Paris Descartes Univ, Ctr Epidemiol & Stat, Obstet Perinatal & Pediat Epidemiol Res Team Epop, Sorbonne Paris Cite,Inserm,UMR 1153,DHU Risks Pre, Paris, France
[2] Grenoble Univ Hosp, Clin Res Ctr CICO3, Grenoble, France
[3] Cochin Univ Hosp, AP HP, Dept Obstet & Gynaecol, Port Royal Matern Unit, Paris, France
关键词
Antenatal detection; fetal growth restriction; obstetric management; small for gestational age; GESTATIONAL-AGE FETUSES; BIRTH-WEIGHT RATIO; RISK; RETARDATION; IDENTIFICATION; STILLBIRTH; CARE;
D O I
10.1111/1471-0528.13148
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
ObjectiveTo assess the proportion of small for gestational age (SGA) and normal birthweight infants suspected of fetal growth restriction (FGR) during pregnancy, and to investigate obstetric and neonatal outcomes by suspicion of FGR and SGA status at birth. DesignPopulation-based study. SettingAll French maternity units in 2010. PopulationRepresentative sample of singleton births (n=14100). MethodsWe compared SGA infants with a birthweight of less than the 10th percentile suspected of FGR, defined as mention of FGR in medical charts (true positives), non-SGA infants suspected of FGR (false positives), SGA infants without suspicion of FGR (false negatives) and non-SGA infants without suspicion of FGR (true negatives). Multivariable analyses were adjusted for maternal and neonatal characteristics hypothesised to affect closer surveillance for FGR and our outcomes. Main outcome measuresObstetric management (caesarean, provider-initiated preterm and early term delivery) and neonatal outcomes (late fetal death, preterm birth, Apgar score, resuscitation at birth). Results21.7% of SGA infants (n=265) and 2.1% of non-SGA infants (n=271) were suspected of FGR during pregnancy. Compared with true negatives, provider-initiated preterm deliveries were higher for true and false positives (adjusted risk ratio [aRR], 6.1 [95% CI, 3.8-9.8] and 4.6 [95% CI, 3.2-6.7]), but not for false negatives (aRR, 1.1 [95% CI, 0.6-1.9]). Neonatal outcomes were not better for SGA infants if FGR was suspected. ConclusionAntenatal suspicion of FGR among SGA infants was low and one-half of infants suspected of FGR were not SGA. The increased risk of provider-initiated delivery observed in non-SGA infants suspected of FGR raises concerns about the iatrogenic consequences of screening.
引用
收藏
页码:518 / 527
页数:10
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