Abstract
Objectives: To compare fetal and neonatal growth charts pertaining to different models
(population-specific, universal reference, universal standard and fully customised)
in detecting suboptimal fetal growth in the third trimester. Methods: This was a prospective
observational study conducted at two fetal medicine centers. After applying the inclusion
criteria [singleton pregnancies between 28 and 40 weeks, verified dates and estimated
fetal weight (EFW) ≤ 25th centile as per the Hadlock chart], 292 women were consecutively
recruited. Four fetal growth charts (Hadlock, Intergrowth, fully customised GROW,
Sonocare) and three neonatal charts (Fenton, Intergrowth and fully customised GROW)
were used in the study. The EFW and birthweight centiles were categorized into three
groups: < 3.0, 3.1–10th and > 10th centiles. The charts were evaluated by their ability
to detect pregnancies with uteroplacental insufficiency and/or development of adverse
neonatal outcomes in the third trimester. Results: Significant difference was noted
between the fetuses/neonates assigned as < 3rd centile (Hadlock-9.3%, Sonocare-4.8%,
Intergrowth- 6.8% and the fully customised GROW- 6.5%) and the neonatal charts (Fenton-18.5%,
Intergrowth- 20.2% and fully customised GROW- 13.4%). At a cut-off of 3rd centile,
the GROW chart had the highest sensitivity (84.2%) followed by Intergrowth (78.9%),
Hadlock (70.37%) and Sonocare (64.29%). Similarly, for a cut-off of < 10th, the sensitivity
was GROW 70.27%, Sonocare 64%, Intergrowth 60.8% and Hadlock 50%. Amongst the neonatal
charts, fully customised GROW chart had the greatest detection rate (< 3rd = 74.36%,
< 10th = 70.27%). However, there was no significant difference between the charts
in the detection of pregnancies with suboptimal fetal growth associated with uteroplacental
insufficiency and/or adverse neonatal outcomes. Conclusion: Despite substantial discrepancy between the growth charts in diagnosing fetal smallness,
adding multivessel Doppler negates significant differences between them in diagnosing
suboptimal fetal growth associated with uteroplacental insufficiency and adverse neonatal
outcomes.
Keywords Fetal growth restriction - Suboptimal fetal growth - Growth Charts - Growth standards
- Reference charts - Multivessel Doppler - Third trimester growth scan - Customised
growth chart
