Am J Perinatol 2001; 18(6): 325-334
DOI: 10.1055/s-2001-17856

Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Accuracy of Single Ultrasound Parameters in Detection of Fetal Growth Restriction

Parvin Niknafs, John Sibbald
  • Faculty of Health and Behavioral Sciences, University of Wollongong, New South Wales, Australia
Further Information

Publication History

Publication Date:
17 October 2001 (online)


The objective of this study was to evaluate the diagnostic accuracy of different single ultrasonographic parameters in predicting intrauterine growth-restricted (IUGR) babies as defined by Ponderal index at birth. Study sample composed of two sets of data from Iran and Australia. The Iranian sample consisted of 296 Iranian women. All the study women received prenatal care and delivered at Fatemieh Hospital in Shahrood, Iran. The data from 219 Australian fetuses were obtained from the ultrasound section at the Wollongong Hospital in Australia. Ultrasonographic measurements of biparietal diameter (BPD), femur length (FL), head circumference (HC), abdominal circumference (AC), amniotic fluid index (AFI), and Doppler from umbilical arteries (S/D ratio) were obtained. Only those pregnancies were included in which the estimated date of delivery (EDD) by LMP (last menstrual period) agreed within 14 days with the estimated date of delivery determined by the initial ultrasound examination. Sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) were calculated for single proposed ultrasound parameters in the Iranian and Australian samples. When different variables are compared, with a cut-off point at or below the 10th percentile AC and HC had the highest sensitivities in the Australian sample while AC was the most sensitive parameter for IUGR detection in the Iranian sample. BPD has a reasonably high sensitivity at this threshold. The AFI ratio has the lowest sensitivity in predicting IUGR in the Australian sample. Positive predictive values were low in all of the parameters in both the Iranian and Australian samples. By increasing the cut-off for PI to the 20th percentile, the sensitivity of reduced AC increased in the Australian sample while the sensitivity for an abnormal S/D ratio and reduced AFI to identify IUGR decreased. Our results indicate that reduced AC was the best single parameter in discriminating between IUGR and non-IUGR fetuses with the highest sensitivity among the proposed parameters in the both Iranian and Australian sample. However, the PPV of this parameter is low. This means that a high number of false-positive cases are detected using each parameter, which reduces the usefulness of identification. Other ultrasound obstetrical parameters may also have a reasonable level of sensitivity, however, the PPV of all parameters is low. On the whole, our results show that although the examined ultrasonographic criteria may detect a group of fetuses that need close antepartum surveillance, none of these parameters are appropriate enough to be used in isolation in clinical practice. Using single ultrasound parameters does not have high sensitivity and PPVs in detection of fetal growth restriction. This limits accuracy and utility of these tests in the detection of IUGR fetuses.


  • 1 Divon M Y. Fetal Growth Restriction.  1st ed. Philadelphia: Lippincott-Raven Publishers 1997: 1-50
  • 2 Barker D, Bull A R, Osmond C, Simmonds S J. Foetal and placental size and risk of hypertension in adult life.  BMJ . 1990;  301 259-301
  • 3 Cater J, Gill M. The follow up study. In: Illsely R, Mitchell RG, eds. Medical Aspects, in Low Birth Weight, A Medical, Physiological and Social Study 1st ed. San Francisco: Chilchester 1984: 191-205
  • 4 Owen P, Khan K. Foetal growth velocity in the prediction of intrauterine growth retardation in a low risk population.  Br J Obstet Gynaecol . 1998;  105 536-540
  • 5 James D, Parker M, Smoleniec J S, Karlson L. Comprehensive foetal assessment with three ultrasonographic characteristics.  Am J Obstet Gynecol . 1992;  166 1487-1495
  • 6 Skovron M I, Berkovitz G S, Lapinski R, Persson L H. Evaluation of early third trimester ultrasound screening for intra-uterine growth retardation.  J Ultrasound Med . 1991;  10 153-159
  • 7 Villar J, Deonis M, Kestler E. The difference neonatal morbidity of the intra-uterine growth retardation syndrome.  Am J Obstet Gynaecol . 1990;  163 151-157
  • 8 Guashino S, Spillino A, Stola E, Ramakers A. The significance of the Ponderal index as a prognosis factor in low birth weight population.  Biol Res Pregnancy . 1986;  7 121-127
  • 9 Khoury M, Berg C J, Calle E. The Ponderal index in term newborn siblings.  Am J Epidemiol . 1990;  132 576-583
  • 10 Yau K I, Chang M. Weight to length ratio: a good parameter for determining nutritional status in preterm and full term newborns.  Acta Paediatr . 1993;  82 427-429
  • 11 Deter R L, Harrist R B, Hadlock F P, Carpenter R J. Foetal head and abdominal circumferences, a clinical re-evaluation of the relationship to menstrual age.  J Clin Ultrasound . 1982;  10 365-372
  • 12 Hadlock F P, Deter R L, Harris R B, Park S E. Foetal biparietal diameter, rationale choice of plane of section for sonographic measurement.  Am J Roentgenol . 1982;  138 181-184
  • 13 Warda A H, Deter R L, Rossavik I, Gohari P. Foetal femur length, a critical re-evaluation of the relationship to menstrual age.  Obstet Gynecol . 1985;  66 69-75
  • 14 Hadlock F P, Deter R L, Harrist R B, Park S K. Foetal biparietal diameter: a critical re-evaluation of the relationship to menstrual age by means of real time ultrasound.  J Ultrasound Med . 1982;  1 97-104
  • 15 Moore T R, Cayle G E. The amniotic fluid index in normal pregnancy.  Am J Obstet Gynecol . 1990;  162 1168-1173
  • 16 Fogarty P. Continuous wave Doppler flow velocity wavefroms from the umbilical artery in normal pregnancy.  J Paediat Med . 1990;  18 51-53
  • 17 Chard T, Yoong A, Macintosh M. The myth of foetal growth retardation at term.  Br J Obstet Gynaecol . 1993;  100 1076-1081
  • 18 Chard T, Costeloe K. Evidence of growth retardation in neonates of apparently normal weight.  Eur J Obstet Gynaecol Rep Biol . 1992;  45 59-62
  • 19 Vintileos A, Lodeiro I G, Feinstein S, Campbell W A. Value of Ponderal index in predicting growth retardation.  Obstetric Gynaecol . 1986;  67 40-43
  • 20 Brown H L, Miller J M, Gabert H A, Kissling G. Ultrasonic recognition the small-for gestational fetus.  Obstet Gynecol . 1987;  60 693-696
  • 21 Nielson J P, Munjanja S P, Whitfield C R. Screening for small for dates fetuses: a controlled trial.  BMJ . 1984;  289 1179-1183
  • 22 Warsof S L, Cooper D J, Little D, Thomas A. Routine ultrasound screening for antenatal detection of intra-uterine growth retardation.  Obstet Gynecol . 1986;  67 33-39
  • 23 David M, Tagliavini G, Pilu G, Rudenholz A. Receiver-operator characteristic curves for the ultrasonographic prediction of small-for gestational age fetuses in low risk pregnancies.  Am J Obstet Gynaecol . 1996;  174 1037-1042
  • 24 Meyer W J, Gauthier D, Ramakrishnan V, Sipos J. Ultrasonographic detection of abnormal foetal growth with the gestational age-independent, transverse cerebellar diameter/abdominal circumference ratio.  Am J Obstet Gynaecol . 1994;  171 1057-1063
  • 25 Geirson R T, Patel N B, Christie A D, Rymark P. Intra-uterine volume, foetal abdominal area, and biparietal diameter measurements with ultrasound in the prediction of small for dates babies in a high risk obstetrics population.  Br J Obstet Gynecol . 1985;  92 936-940
  • 26 Chang T C, Robson S C, Spencer J A, Gallivan S. Identification of foetal growth retardation: comparison of Doppler waveforms indices and serial ultrasound measurement of abdominal circumference and foetal weight.  Obstet Gynecol . 1993;  82 231-235
  • 27 Chang T C, Boys R J, Marcog J A, Robson S C. Prediction of the small for gestational age infant: which ultrasound measurement is the best?.  Obstet Gynecol . 1992;  80 1030-1035
  • 28 Deter R L, Harrist R B, Hadlock F P, Carpenter R J. Foetal head and abdominal circumstances, a clinical re-evaluation of the relationship to menstrual age.  J Clin Ultrasound . 1982;  10 365-372
  • 29 Crane J P, Kopta M M. Comparative newborn antropometric data in symmetric versus asymmetric intra-uterine growth retardation.  Am J Obstet Gynecol . 1980;  138 518-522
  • 30 Bewley S, Cooper D, Campbell S. Doppler investigation of uteroplacental circulation in the second trimester.  Br J Obstet Gynecol . 1991;  98 871-873
  • 31 Jacobson S L, Imhof R, Manning N, Miller M. The value of Doppler assessment of the uteroplacental circulation in predicting pre-eclampsia or intra-uterine growth retardation.  Am J Obstet Gynaecol . 1990;  162 110-113
  • 32 Chambers E, Hoskins P R, Haddad N G, Freeman N A. Comparison of foetal abdominal circumference measurements and Doppler ultrasound in the prediction of SGA babies.  Br J Obstet Gynecol . 1989;  96 803-806
  • 33 Newnham J P, O'Dea M R, Reid K, Diepeveen D A. Doppler flow velocity waveform analysis in high risk pregnancies: a randomised controlled trial.  Br J Obstet Gynaecol . 1991;  98 956-963
  • 34 Miller J M, Gabert H A. Comparison of dynamic and Doppler ultrasonography for the diagnosis of the small for gestational age fetus.  Am J Obstet and Gynaecol . 1992;  166 1820-1826
  • 35 Gaziano E P. Antenatal ultrasound and foetal Doppler: diagnosis and outcome in intra-uterine growth retardation.  Clin Perinatol . 1995;  22 111-139
  • 36 Gaziano E P, Knox H, Ferrera B, Allen T E. Pulsed Doppler umbilical artery waveforms in multiple gestations: comparison with ultrasound estimated foetal weight for the diagnosis of the small-for-gestational age infants.  J Matern Foetal Invest . 1992;  1 277-282
  • 37 Berkowitz G S, Mehalek K E, Chitkara U, Rosenberg J, Gogswell C. Doppler umbilical velocimetry in the prediction of adverse outcome in pregnancies at risk for intra-uterine growth retardation.  Obstet Gynaecol . 1988;  71 742-747
  • 38 Kazzi G M, Gross T L, Sokol R J, Breckle R. Detection of intra-uterine growth retardation: a new use for sonographic placental grading.  Am J Obstet Gynaecol . 1983;  145 733-755