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Routine third trimester ultrasonography in predicting adverse perinatal outcomes: a prospective cohort study at a tertiary-care hospital in Eastern India

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Abstract

Aims

Fetal growth restriction (FGR) may go undetected in the antenatal period with subjective clinical evaluation, and there is a growing propensity to perform a third-trimester scan, especially in the developed countries. The literature on the importance of the same in developing countries like ours, is scant. Hence, this study was undertaken to evaluate the role of routine third-trimester ultrasonography along with Doppler in predicting adverse perinatal outcome.

Methods

A prospective cohort study was conducted at a tertiary-care hospital, in which routine third-trimester ultrasonography was performed for 265 antenatal women, and included estimation of amniotic fluid index (AFI), estimated fetal-weight (EFW), and cerebroplacental ratio (CPR). Women were categorized as having normal parameters or having at least one abnormal parameter. Post-natal adverse perinatal outcomes including low birth-weight, hypoglycemia, poor Apgar scores, prolonged hospital stay, need for ventilatory support, neonatal asphyxia, neonatal sepsis and early neonatal death were recorded. Prediction analyses for sensitivity, specificity, positive and negative predictive values were done. Receiver Operating Characteristic (ROC) curves were plotted for threshold for each parameter for adverse outcome.

Results

Out of 260 women that were analyzed, 47.5% had no clinically identifiable risk factors, and 52.5% had at least one abnormal parameter. Sensitivity and negative predictive value for adverse outcome were highest for composite ultrasound finding (85.4% and 90.4% respectively). Specificity, positive predictive value and diagnostic accuracy were highest for CPR (97.8%, 86.7% and 76.9% respectively).

Conclusion

Routine third trimester ultrasonography, including Doppler, can help in risk-stratification of otherwise clinically low-risk pregnancies.

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Data availability

Data is available with the corresponding author on request.

References

  1. World Health Organization. Evidence and Recommendations (2016) WHO recommendations on antenatal care for a positive pregnancy experience. pp 58–60

  2. Royal College of Obstetricians and Gynaecologists (2014) Green-top guideline No. 31: Small-for-Gestational-Age Fetus, Investigation and Management. RCOG

  3. Lawn JE, Blencowe H, Waiswa P et al (2016) Stillbirths: rates, risk factors, and acceleration towards 2030. The Lancet 387(10018):587–603

    Article  Google Scholar 

  4. Mecacci F, Serena C, Avagliano L et al (2016) Stillbirths at term: case control study of risk factors growth status and placental histology. PLoS ONE. https://doi.org/10.1371/journal.pone.0166514

    Article  PubMed  PubMed Central  Google Scholar 

  5. DeVore GR (2015) The importance of the cerebroplacental ratio in the evaluation of fetal well-being in SGA and AGA fetuses. Am J Obstet Gynecol 213(1):5–15

    Article  PubMed  Google Scholar 

  6. Morales-Roselló J, Khalil A, Morlando M, Bhide A, Papageorghiou A, Thilaganathan B (2015) Poor neonatal acid–base status in term fetuses with low cerebroplacental ratio. Ultrasound Obstet Gynecol 45(2):156–161

    Article  PubMed  Google Scholar 

  7. Kwon J-Y, Kwon H-S, Kim Y-H, Park Y-W (2006) Abnormal Doppler velocimetry is related to adverse perinatal outcome for borderline amniotic fluid index during third trimester. J Obstet Gynaecol Res 32(6):545–549

    Article  PubMed  Google Scholar 

  8. Yadav V, Sharma JB, Kachhawa G, Kulshrestha V, Mahey R, Kumari R, Kriplani A (2019) Obstetrical and perinatal outcome in pregnant women with extrapulmonary tuberculosis. Indian J Tuberc 66(1):158–162

    Article  PubMed  Google Scholar 

  9. Cates JE, Unger HW, Briand V et al (2017) Malaria, malnutrition, and birthweight: a meta-analysis using individual participant data. PLoS Med 14(8):e1002373

    Article  PubMed  PubMed Central  Google Scholar 

  10. Choi SR (2016) Borderline amniotic fluid index and perinatal outcomes in the uncomplicated term pregnancy. J Matern-Fetal Neonatal Med 29(3):457–460

    Article  CAS  PubMed  Google Scholar 

  11. Patel PK, Pitre DS, Gupta H (2015) Pregnancy outcome in isolated oligohydramnios at term. Natl J Commun Med 6(2):84–88

    Google Scholar 

  12. Shrem G, Nagawkar SS, Hallak M, Walfisch A (2016) Isolated oligohydramnios at term as an indication for labor induction: a systematic review and meta-analysis. Fetal Diagn Ther 40(3):161–173

    Article  PubMed  Google Scholar 

  13. Chate P, Khatri M, Hariharan C (2016) Pregnancy outcome after diagnosis of oligohydramnios at term. Int J Reprod Contracept Obstet Gynecol 2(1):23–26

    Google Scholar 

  14. Lees CC, Stampalija T, Baschat AA et al (2020) ISUOG Practice Guidelines: diagnosis and management of small-for-gestational-age fetus and fetal growth restriction. Ultrasound Obstet Gynecol 56(2):298–312

    Article  CAS  PubMed  Google Scholar 

  15. Kabiri D, Romero R, Gudicha DW et al (2020) Prediction of adverse perinatal outcome by fetal biometry: comparison of customized and population-based standards. Ultrasound Obstet Gynecol 55(2):177–188

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Triunfo S, Crispi F, Gratacos E, Figueras F (2017) Prediction of delivery of small-for-gestational-age neonates and adverse perinatal outcome by fetoplacental Doppler at 37 weeks’ gestation. Ultrasound Obstet Gynecol 49(3):364–371

    Article  CAS  PubMed  Google Scholar 

  17. Caradeux J, Eixarch E, Mazarico E, Basuki TR, Gratacos E, Figueras F (2018) Longitudinal growth assessment for prediction of adverse perinatal outcome in fetuses suspected to be small-for-gestational age. Ultrasound Obstet Gynecol 52(3):325–331

    Article  CAS  PubMed  Google Scholar 

  18. Conde-Agudelo A, Villar J, Kennedy SH, Papageorghiou AT (2018) Predictive accuracy of cerebroplacental ratio for adverse perinatal and neurodevelopmental outcomes in suspected fetal growth restriction: systematic review and meta-analysis. Ultrasound Obstet Gynecol 52(4):430–441

    Article  CAS  PubMed  Google Scholar 

  19. Dunn L, Sherrell H, Kumar S (2017) Review: Systematic review of the utility of the fetal cerebroplacental ratio measured at term for the prediction of adverse perinatal outcome. Placenta 54:68–75

    Article  PubMed  Google Scholar 

  20. Nassr AA, Abdelmagied AM, Shazly SA (2016) Fetal cerebro-placental ratio and adverse perinatal outcome: systematic review and meta-analysis of the association and diagnostic performance. J Perinat Med 44(2):249–256

    Article  PubMed  Google Scholar 

  21. Vollgraff Heidweiller-Schreurs CA, De Boer MA, Heymans MW et al (2018) Prognostic accuracy of cerebroplacental ratio and middle cerebral artery Doppler for adverse perinatal outcome: systematic review and meta-analysis. Ultrasound Obstet Gynecol 51(3):313–322

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. The Departments of Obstetrics & Gynecology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, Odisha, 751019, India

    Priyanka Dasgupta, Sweta Singh & Jasmina Begum

  2. Neonatology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, Odisha, 751019, India

    Pankaj Kumar Mohanty

Authors
  1. Priyanka Dasgupta
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  2. Sweta Singh
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  3. Jasmina Begum
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  4. Pankaj Kumar Mohanty
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Contributions

All authors contributed to study design and concept. PD wrote the first draft of the manuscript. All authors helped in data collection and preparation of the final manuscript to be submitted. The manuscript has been read and approved by all the authors, the requirements for authorship as stated earlier in this document have been met, and each author believes that the manuscript represents honest work.

Corresponding author

Correspondence to Sweta Singh.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institute Ethics Committee of All India Institute of Medical Sciences, Bhubaneswar reference number IEC/AIIMS BBSR/PG Thesis/2018- 19/36 dated.

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Informed consent was obtained from all individual participants included in the study.

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Dasgupta, P., Singh, S., Begum, J. et al. Routine third trimester ultrasonography in predicting adverse perinatal outcomes: a prospective cohort study at a tertiary-care hospital in Eastern India. J Ultrasound 26, 777–784 (2023). https://doi.org/10.1007/s40477-022-00753-5

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  • DOI: https://doi.org/10.1007/s40477-022-00753-5

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