Symphysis Fundus Measurements used with a novel Statistical Method for detection of Intrauterine Growth Retardation; a Clinical Evaluation.

• Objective: The statistical method of Shiryaev-Roberts (SR method), using altered growth speed, in combination with symphysis fundus (SF) measurements has theoretically a potential to improve antenatal detection of intrauterine growth restricted (IUGR) fetuses. The main objective of the present study was to compare the ability of the SR method and the SF method (SF measurements compared with a population based reference curve) to identify IUGR and small for gestational age (SGA) fetuses. Design: A longitudinal study design. Setting: Pregnant women from 27 primary antenatal care centres in 4 counties. Population: One thousand eight hundred and eighty eight women with singleton ultrasound dated pregnancies. Methods: Weekly self-administered SF measurements from gestational week 25 until delivery were analysed according to the SR method. Neonatal morbidity was used as a proxy for IUGR. SGA was defined as a birth weight < -2 standard deviations (SD) or < 10th percentile. Sensitivity for neonatal morbidity and SGA were assessed for alarms given for 5 to 30 % of the study population according to the SR-method and compared with the SF method. Main outcome measures: Respiratory distress, hypoglycaemia, Apgar < 7 at 5 min, pH < 7.01 in the umbilical artery, neonatal care, preterm delivery, operative delivery for fetal distress, SGA and any neonatal morbidity. Results: SF measurements from 1122 pregnant women were evaluated. For the SR method sensitivity for neonatal morbidity was between 6.0 and 36.4 %, for SGA (< -2 SD) 36.8 %, and for SGA (< 10th percentile) 20.9 %. The SF method had a sensitivity between 6.0 and 13.8% for neonatal morbidity, for SGA (< -2 SD) 52.3 % and for SGA (< 10th percentile) 28.6 %. Neonates classified as SGA (< -2SD and < 10th percentile) had increased morbidity. Neonates suspected to be SGA before delivery by the SF method had lower morbidity than those not suspected. Conclusions: The SR method was not found to improve detection of fetuses with increased morbidity or SGA neonates in this study. SGA neonates defined as < – 2 SD or < 10th percentile have increased neonatal morbidity.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Reproduktionsmedicin och gynekologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Obstetrics, Gynaecology and Reproductive Medicine (hsv//eng)

Keyword

symphysis-fundus measurements

self-administered

intrauterine growth retardation (IUGR)

small for gestational age (SGA)

relative growth

fetal growth

Obstetrics and gynaecology

Obstetrik och gynekologi

Obstetrics and Gynaecology

Obstetrik och gynekologi

Publication and Content Type

vet (subject category)

ovr (subject category)