Article

The risk of intrauterine fetal death in the small-for-gestational-age fetus.

Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR. Electronic address: .
American journal of obstetrics and gynecology (Impact Factor: 3.97). 10/2012; 207(4):318.e1-6. DOI: 10.1016/j.ajog.2012.06.039
Source: PubMed

ABSTRACT We sought to evaluate the risk of intrauterine fetal death (IUFD) in small-for-gestational-age (SGA) fetuses.
We analyzed a retrospective cohort of all births in the United States in 2005, as recorded in a national database. We calculated the risk of IUFD within 3 sets of SGA threshold categories as well as within non-SGA pregnancies using the number of at-risk fetuses as the denominator.
The risk of IUFD increased with gestational age and was inversely proportional to percentile of birthweight for gestational age. The risk for IUFD in those <3rd percentile was as high as 58.0 IUFDs per 10,000 at-risk fetuses, 43.9 for <5th percentile, and 26.3 for <10th percentile compared to 5.1 for non-SGA gestations.
There is an increase in the risk of IUFD in SGA fetuses compared to non-SGA fetuses at all gestational ages with the greatest risk demonstrated in the lowest percentile cohort evaluated.

1 Bookmark
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective. To investigate copeptin as a biomarker for small-for-gestational-age. Methods. We conducted a nested case-control study on maternal copeptin levels measured in gestational week 12 and 19 and risk of small-for-gestational age. Cases were defined as pregnant women who delivered a small-for-gestational-age infant. Small-for-gestational age was defined as a birth weight − 22% or less than expected according to gestational age (n = 39). Controls were pregnant women who delivered a normal-weight infant (n = 119). The copeptin ultrasensitive Kryptor kit (BRAHMS) was used to determine copeptin in maternal serum. We established reference ranges for copeptin by 95% prediction intervals with 90% confidence intervals. Paired and unpaired t-tests were performed to test the null-hypothesis of no difference in copeptin levels within and between the groups. Results. The reference intervals for copeptin in normal pregnancies were 1.24–5.51 pmol/L (90% confidence intervals on upper and lower limit were 1.13–1.37 and 5.00–6.08 pmol/L) at gestational week 12, and 1.30–5.09 pmol/L (90% confidence intervals were 1.19–1.42 and 4.65–5.57 pmol/L) at gestational week 19. Copeptin levels decreased from week 12–19 in cases (p = 0.02), whereas no change was observed in controls (p = 0.61). We found no difference in copeptin levels in cases compared to controls in gestational week 12 (p = 0.10) and week 19 (p = 0.81). Conclusion. The present study could not demonstrate copeptin as a novel biomarker for small-for-gestational-age.
    Scandinavian Journal of Clinical and Laboratory Investigation 08/2014; 74(8). · 2.01 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Study Question. To determine whether the umbilical cord insertion site of singleton pregnancies could be linked to the newborn birth weight at term and its individual growth potential achievement. Material and Methods. A cohort study including 528 records of term neonates was performed. Each neonate was assessed for growth adjusted for gestational age according to the infant's growth potential using the AUDIPOG module. We considered two categories of umbilical cord insertions: central and peripheral. Intrauterine growth restriction was defined as birth weight below the 10th percentile. Statistical analysis was performed using Chi-square, Student's t test, Wilcoxon test, ANOVA, and logistic regression. Results. We observed a total of 343 centrally inserted cords versus 185 peripheral cords. There were twice as many smokers in the mothers of the peripheral category compared to the centrally inserted ones. More importantly, we demonstrated that only 17/343 (5.0%) of infants with central cord insertion were growth restricted, compared to 37/185 (20.0%) of the infants born with a peripheral insertion. Neonates with centrally inserted cord were significantly heavier. Conclusion. The umbilical cord insertion site of singleton pregnancies is associated with the newborn's birth weight at term and its individual growth potential achievement.
    BioMed Research International 01/2014; 2014:341251. · 2.71 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective To 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 = 14 100).Methods We 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.Conclusion Antenatal 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.
    BJOG An International Journal of Obstetrics & Gynaecology 10/2014; · 3.76 Impact Factor