Resumé

Introduction: It is well established that correct antenatal identification of small-for-gestational-age (SGA) fetuses reduces their risk of adverse perinatal outcome with long-term consequences. Ultrasound estimates of fetal weight (EFWus) are the ultimate tool for this identification. It can be conducted as a “universal screening”, that is, all pregnant women at a specific gestational age. However, in Denmark it is conducted as “selective screening”, that is, only on clinical indication. The aim of this study was to assess the performance of the Danish national SGA screening program and the consequences of false-positive and false-negative SGA cases. Material and methods: In this retrospective cohort study, we included 2928 women with singleton pregnancies with due dates in 2015. We defined “risk of SGA” by an EFWus ≤ −15% of expected for the gestational age and “SGA” as birthweight ≤−22% of expected for gestational age. Results: At birth, the prevalence of SGA was 3.3%. The overall sensitivity of the Danish screening program was 62% at a false-positive rate of 5.6%. Within the entire cohort, 63% had an EFWus compared with 79% of the SGA cases. The sensitivity was 79% for those born before 37 weeks of gestation but only 40% for those born after 40 weeks of gestation. The sensitivity was also associated with birthweight deviation; 73% among extreme SGA cases (birthweight deviation ≤−33%) and 55% among mild SGA (birthweight deviation between −22% and −27%). False diagnosis of SGA was associated with an increased rate of induction of labor (ORadj = 2.51, 95% CI 1.70-3.71) and cesarean section (ORadj = 1.44, 95% CI 0.96-2.18). Conclusions: The performance of the Danish national screening program for SGA based on selective EFWus on clinical indication has improved considerably over the last 20 years. Limitations of the program are the large proportion of women referred to ultrasound scan and the low performance post-term.

OriginalsprogEngelsk
TidsskriftActa Obstetricia et Gynecologica Scandinavica
ISSN0001-6349
DOI
StatusE-pub ahead of print - 31 okt. 2019

Fingerprint

Gestational Age
Fetus
Pregnancy
Induced Labor
Fetal Weight
Denmark
Cesarean Section
Pregnant Women
Cohort Studies
Retrospective Studies
Parturition

Emneord

  • estimated fetal weight
  • outcome
  • performance
  • screening
  • Small-for-gestational-age
  • ultrasound

Citer dette

@article{ee93c7e0eac746efac5eabef4449fc81,
title = "Screening for small-for-gestational-age fetuses",
abstract = "Introduction: It is well established that correct antenatal identification of small-for-gestational-age (SGA) fetuses reduces their risk of adverse perinatal outcome with long-term consequences. Ultrasound estimates of fetal weight (EFWus) are the ultimate tool for this identification. It can be conducted as a “universal screening”, that is, all pregnant women at a specific gestational age. However, in Denmark it is conducted as “selective screening”, that is, only on clinical indication. The aim of this study was to assess the performance of the Danish national SGA screening program and the consequences of false-positive and false-negative SGA cases. Material and methods: In this retrospective cohort study, we included 2928 women with singleton pregnancies with due dates in 2015. We defined “risk of SGA” by an EFWus ≤ −15{\%} of expected for the gestational age and “SGA” as birthweight ≤−22{\%} of expected for gestational age. Results: At birth, the prevalence of SGA was 3.3{\%}. The overall sensitivity of the Danish screening program was 62{\%} at a false-positive rate of 5.6{\%}. Within the entire cohort, 63{\%} had an EFWus compared with 79{\%} of the SGA cases. The sensitivity was 79{\%} for those born before 37 weeks of gestation but only 40{\%} for those born after 40 weeks of gestation. The sensitivity was also associated with birthweight deviation; 73{\%} among extreme SGA cases (birthweight deviation ≤−33{\%}) and 55{\%} among mild SGA (birthweight deviation between −22{\%} and −27{\%}). False diagnosis of SGA was associated with an increased rate of induction of labor (ORadj = 2.51, 95{\%} CI 1.70-3.71) and cesarean section (ORadj = 1.44, 95{\%} CI 0.96-2.18). Conclusions: The performance of the Danish national screening program for SGA based on selective EFWus on clinical indication has improved considerably over the last 20 years. Limitations of the program are the large proportion of women referred to ultrasound scan and the low performance post-term.",
keywords = "estimated fetal weight, outcome, performance, screening, Small-for-gestational-age, ultrasound",
author = "{Nymark Hansen}, Ditte and {Sand Odgaard}, Helle and Niels Uldbjerg and Marianne Sinding and Anne S{\o}rensen",
year = "2019",
month = "10",
day = "31",
doi = "10.1111/aogs.13764",
language = "English",
journal = "Acta Obstetricia et Gynecologica Scandinavica",
issn = "0001-6349",
publisher = "Wiley",

}

Screening for small-for-gestational-age fetuses. / Nymark Hansen, Ditte; Sand Odgaard, Helle; Uldbjerg, Niels; Sinding, Marianne; Sørensen, Anne.

I: Acta Obstetricia et Gynecologica Scandinavica, 31.10.2019.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Screening for small-for-gestational-age fetuses

AU - Nymark Hansen, Ditte

AU - Sand Odgaard, Helle

AU - Uldbjerg, Niels

AU - Sinding, Marianne

AU - Sørensen, Anne

PY - 2019/10/31

Y1 - 2019/10/31

N2 - Introduction: It is well established that correct antenatal identification of small-for-gestational-age (SGA) fetuses reduces their risk of adverse perinatal outcome with long-term consequences. Ultrasound estimates of fetal weight (EFWus) are the ultimate tool for this identification. It can be conducted as a “universal screening”, that is, all pregnant women at a specific gestational age. However, in Denmark it is conducted as “selective screening”, that is, only on clinical indication. The aim of this study was to assess the performance of the Danish national SGA screening program and the consequences of false-positive and false-negative SGA cases. Material and methods: In this retrospective cohort study, we included 2928 women with singleton pregnancies with due dates in 2015. We defined “risk of SGA” by an EFWus ≤ −15% of expected for the gestational age and “SGA” as birthweight ≤−22% of expected for gestational age. Results: At birth, the prevalence of SGA was 3.3%. The overall sensitivity of the Danish screening program was 62% at a false-positive rate of 5.6%. Within the entire cohort, 63% had an EFWus compared with 79% of the SGA cases. The sensitivity was 79% for those born before 37 weeks of gestation but only 40% for those born after 40 weeks of gestation. The sensitivity was also associated with birthweight deviation; 73% among extreme SGA cases (birthweight deviation ≤−33%) and 55% among mild SGA (birthweight deviation between −22% and −27%). False diagnosis of SGA was associated with an increased rate of induction of labor (ORadj = 2.51, 95% CI 1.70-3.71) and cesarean section (ORadj = 1.44, 95% CI 0.96-2.18). Conclusions: The performance of the Danish national screening program for SGA based on selective EFWus on clinical indication has improved considerably over the last 20 years. Limitations of the program are the large proportion of women referred to ultrasound scan and the low performance post-term.

AB - Introduction: It is well established that correct antenatal identification of small-for-gestational-age (SGA) fetuses reduces their risk of adverse perinatal outcome with long-term consequences. Ultrasound estimates of fetal weight (EFWus) are the ultimate tool for this identification. It can be conducted as a “universal screening”, that is, all pregnant women at a specific gestational age. However, in Denmark it is conducted as “selective screening”, that is, only on clinical indication. The aim of this study was to assess the performance of the Danish national SGA screening program and the consequences of false-positive and false-negative SGA cases. Material and methods: In this retrospective cohort study, we included 2928 women with singleton pregnancies with due dates in 2015. We defined “risk of SGA” by an EFWus ≤ −15% of expected for the gestational age and “SGA” as birthweight ≤−22% of expected for gestational age. Results: At birth, the prevalence of SGA was 3.3%. The overall sensitivity of the Danish screening program was 62% at a false-positive rate of 5.6%. Within the entire cohort, 63% had an EFWus compared with 79% of the SGA cases. The sensitivity was 79% for those born before 37 weeks of gestation but only 40% for those born after 40 weeks of gestation. The sensitivity was also associated with birthweight deviation; 73% among extreme SGA cases (birthweight deviation ≤−33%) and 55% among mild SGA (birthweight deviation between −22% and −27%). False diagnosis of SGA was associated with an increased rate of induction of labor (ORadj = 2.51, 95% CI 1.70-3.71) and cesarean section (ORadj = 1.44, 95% CI 0.96-2.18). Conclusions: The performance of the Danish national screening program for SGA based on selective EFWus on clinical indication has improved considerably over the last 20 years. Limitations of the program are the large proportion of women referred to ultrasound scan and the low performance post-term.

KW - estimated fetal weight

KW - outcome

KW - performance

KW - screening

KW - Small-for-gestational-age

KW - ultrasound

U2 - 10.1111/aogs.13764

DO - 10.1111/aogs.13764

M3 - Journal article

JO - Acta Obstetricia et Gynecologica Scandinavica

JF - Acta Obstetricia et Gynecologica Scandinavica

SN - 0001-6349

ER -