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- W4200328739 abstract "SMFM Consult #52 recommends diagnosis of fetal growth restriction (FGR) if either estimated fetal weight or fetal AC is <10th percentile. The Consult recommends a Hadlock reference for EFW %iles but does not specify a reference for AC %iles. Our goal was to evaluate the Hadlock 1984 reference for AC compared to 3 recent standards: Intergrowth 21st (Papageorghiou 2014); NICHD Fetal Growth Studies (Buck Louis 2015); and WHO Growth Study (Kiserud 2017). Retrospective cohort study of ultrasound exams submitted for quality audit by 6 MFM practices in USA. Inclusion criteria: singleton, living fetus, gestational age (GA) 22.0 to 39.9 wks, complete biometry measurement. For patients with >1 eligible exam, 1 exam was selected randomly. Exploratory cohort: 2019 data from 3 practices, n=5932 patients. Using each reference, we evaluated z-scores of AC based on fit to expected mean=0 and standard deviation (SD)=1, variation of fit across GA, and fraction of exams with AC >90th %ile or AC <10th %ile. Two references were judged superior. This judgement was tested using an independent validation cohort: 2020 data from 3 different practices, n=9084. Figure 1 shows the overall fit of our data to the 4 references. Hadlock and Buck Louis (White) references had mean z-scores close to 0 and SD close to 1, with slight superiority of Buck Louis. The other references had z-scores shifted far to the right (mean >0.4), producing a relative excess of AC >90th %ile and deficit of AC <10th %ile. As shown in Figure 2, SD of z-scores using Hadlock was only 0.7 at 22-27 wks versus 1.4 at 34-39 wks, producing a steadily increasing fraction of abnormal exams (AC >90th %ile or AC <10th %ile) with increasing GA. For the Buck Louis reference, SD of z did not vary systematically by GA. Hadlock and Buck Louis norms had similar rates of diagnosis of FGR. These observations were confirmed in the validation cohort. Hadlock and NICHD Fetal Growth norms fit our data more closely than Intergrowth 21st or WHO norms. The fit of Hadlock norms, but not NICHD norms, varied by GA.View Large Image Figure ViewerDownload Hi-res image Download (PPT)" @default.
- W4200328739 created "2021-12-31" @default.
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- W4200328739 date "2022-01-01" @default.
- W4200328739 modified "2023-10-06" @default.
- W4200328739 title "Choice of reference for fetal abdominal circumference (AC) percentiles" @default.
- W4200328739 doi "https://doi.org/10.1016/j.ajog.2021.11.1130" @default.
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