Detection of Fetal Growth Restriction with Preterm Severe Preeclampsia: Experience at Two Tertiary Centers

ABSTRACT

Our objective was to determine if sonographic estimate of fetal weight (SEFW) can identify fetal growth restriction (FGR; birthweight < 10% for gestational age [GA]) among patients with preterm (28 to 32 weeks) severe preeclampsia (P SPE). At two centers, all singletons with reliable GA, P SPE, and SEFW within 3 weeks of birth were identified retrospectively. Intrauterine growth restriction was SEFW ≤ 10% for GA. Likelihood ratio (LR) and guidelines by an Evidence-Based Medicine Working Group were used. At the two centers, IUGR was suspected in 20% (4 of 20) and 28% (5 of 18) of P SPE, and FGR was noted in 35% and 44%. At one center, suspected intrauterine growth restriction (IUGR) was associated with actual FGR in 50% of the cases and at center II, in 80%. The LR for IUGR to identify FGR was 3.0. We concluded that SEFW is not a useful diagnostic test in identifying FGR among patients with preterm SPE.

KEYWORDS

Preterm severe preeclampsia - sonographic estimate of fetal weight - intrauterine growth restriction - likelihood ratio

REFERENCES

• 1 American College of Obstetricians and Gynecologists .Diagnosis and management of preeclampsia and eclampsia. ACOG Practice Bulletin No. 33. Washington, DC; ACOG 2002
• 2 Sibai B M, Mercer B M, Schiff E, Friedman S A. Aggressive versus expectant management of severe preeclampsia at 28 to 32 weeks' gestation: a randomized controlled trial.  Am J Obstet Gynecol. 1994;  171 818-822
• 3 American College of Obstetricians and Gynecologists .Ultrasonography in pregnancy. ACOG Practice Bulletin No. 58. Washington, DC; ACOG 2004
• 4 Hadlock F P, Harrist R B, Sharman R S, Deter R L, Park S K. Estimation of fetal weight with the use of head, body, and femur measurements-a prospective study.  Am J Obstet Gynecol. 1985;  151 333-337
• 5 Alexander G R, Himes J H, Kaufman R B, Mor J, Kogan M. A United States national reference for fetal growth.  Obstet Gynecol. 1996;  87 163-168
• 6 Jaeschke R, Guyatt G H, Sackett D L for the Evidence-Based Medicine Working Group. Users' guide to the medical literature III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients?.  JAMA. 1994;  271 703-707
• 7 Haddad B, Kayem G, Deis S, Sibai B M. Are perinatal and maternal outcomes different during expectant management of severe preeclampsia in the presence of intrauterine growth restriction?.  Am J Obstet Gynecol. 2007;  196(3) 237.e1-5
• 8 Chauhan S P, Hendrix N W, Magann E F, Morrison J C, Scardo J A, Berghella V. A review of sonographic estimate of fetal weight: vagaries of accuracy.  J Matern Fetal Neonatal Med. 2005;  18 211-220