Citation Information :
de Silva RS, Perera H. Serial Measurements of Fetal Head Circumference and Abdominal Circumference to Predict Fetal Growth Restriction in a Sri Lankan Study Population. J South Asian Feder Obs Gynae 2021; 13 (4):202-206.
Aim and objective: Prediction of fetal growth restriction (FGR) by serial ultrasound measurement of head circumference (HC) and abdominal circumference (AC) of the fetus applied routinely to all mothers irrespective of risk status for FGR and small for gestational age.
Materials and methods: A prospective study was done of 508 pregnant women who underwent two successive growth scans 4 weeks apart at Sri Jayewardenepura General Hospital, Sri Lanka. FGR was identified by graphically plotting serial fetal AC and HC. Postnatally, growth restriction was diagnosed based on ponderal index (PI). Sensitivity, specificity, positive predictive value, and likelihood ratio of predicting FGR by successive serial ultrasound measurements of fetal AC and HC were calculated.
Results: Based on fetal AC and HC, FGR was present in 223 of 508 fetuses (43.89%). Based on PI, 224 of 508 (44.1%) neonates were growth-restricted. Sensitivity, specificity, positive predictive value, positive likelihood ratio, and negative likelihood ratio of predicting FGR by serial fetal AC and HC were 82.59, 86.62, 82.59%, 6.2, and 0.2, respectively.
Conclusion: Serial ultrasound measurements of fetal AC and HC plotted on a fetal growth centile chart routinely carried out in all mothers irrespective of risk status for FGR increases the detection of FGR.
Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: When? Where? Why? Why? Lancet 2005;365(9462):891–900. DOI: 10.1016/S0140-6736(05)71048-5.
Green-top guideline No 31. The investigation and management of small for gestational age fetus. 2nd ed. 2013.
Luesley DM, Baker NP. Obstetrics and gynaecology: an evidence-based text for MRCOG. 2nd ed. 2004. p. 251–259.
Ott WJ. Diagnosis of intrauterine growth restriction: comparison of ultrasound parameters. Am J Perinatol 2002;19(3):133–137. DOI: 10.1055/s-2002-25313.
Figueras F, Gardosi J. Intrauterine growth restriction: new concepts in antenatal surveillance, diagnosis, and management. Am J Obstet Gynecol 2011;204(4):288–300. DOI: 10.1016/j.ajog.2010.08.055.
Hales CN, Barker DJP. The thrifty phenotype hypothesis: type 2 diabetes. Br Med Bull 2001;60:5–20. DOI: 10.1093/bmb/60.1.5.
Barker DJP. The malnourished baby and infant: relationship with type 2 diabetes. Br Med Bull 2001;60(1):69–88. DOI: 10.1093/bmb/60.1.69.
Demicheva E, Crispi F. Long term follow up of intrauterine growth restriction: cardiovascular disorders. Fetal Diagn Ther 2014;36(2): 143–153. DOI: 10.1159/000353633.
Cosmi E, Fanelli T, Visentin S, et al. Consequences in infants that were intrauterine growth restricted. J Pregnancy 2011;2011:364381. DOI: 10.1155/2011/364381.
Loughna P, Chitty L, Evans T, et al. Fetal size and dating: charts recommended for clinical obstetric practice. Ultrasound 2009;17(3):161–167. DOI: 10.1179/174313409X448543.
Papageorghiou A, Ohuma EO, Altman DG, et al. International standards for fetal growth based on serial ultrasound measurements: the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project. Lancet 2014;384(9946):869–879. DOI: 10.1016/S0140-6736(14)61490-2.
Owen P, Ogah J, Bachmann BLM, et al. Prediction of intrauterine growth restriction with customized estimated fetal weight centiles. BJOG 2003;110(4):411–415.
Morse K, Williams A, Gardosi J. Fetal growth screening by fundal height measurement. Best Pract Res Clin Obstet Gynaecol 2009;23(6):809–818. DOI: 10.1016/j.bpobgyn.2009.09.004.
Dias T, Shanmugaraja V, Ganeshamoorthy P, et al. Birthweight standards – ability of birthweight percentiles in predicting abnormal fetal growth and outcome. Sri Lanka J Obstet Gynaecol 2014;36(4): 85–88. DOI: 10.4038/sljog.v36i4.7729.
Onyiriuka AN, Okkolo AA. Small for gestational age, ponderal index and neonatal polycythemia: a study of their association with maternal hypertension among Nigerian women. Ann Afr Med 2005;4(4):154–159.
Akram DS, Arif F. Ponderal index of low birth weight babies – a hospital based study. JPMA 2005;55(6):229–231.
Vinthilions AM, Lodeiro JG, Fenestein SJ, et al. Value of fetal ponderal index in predicting growth retardation. Obstet Gynecol 1986;67(4):584–588.
Fay RA, Dey PL, Saadie CM, et al. Ponderal index: a better definition of the ‘at risk’ group with intrauterine growth problems than birth-weight for gestational age in term infants. Aust N Z J Obstet Gynecol 1991;31(1):17–19. DOI: 10.1111/j.1479-828x.1991.tb02755.x.
Davis DP, Platts P, Pritchard JM, et al. Nutritional status of light-for -date infants at birth and its influence on early postnatal growth. Arch Dis Childhood 1979;54:703–706.
Oluwafemi OR, Njokanma FO, Disu EA, et al. Current pattern of Ponderal Indices of term small for gestational age in a population of Nigerian babies. BMC Pediatr 2013;13:110–117. DOI: 10.1186/1471-2431-13-110.
Roje D, Banovic I, Tadin I, et al. Gestational age – the most important factor of neonatal ponderal index. Yonsei Med J 2004;45(2):273–280. DOI: 10.3349/ymj.2004.45.2.273.
Nili F, Makipour M, Mobini J. The value of ponderal index as a prognostic factor in predicting complications in term neonates. Med J Islamic Repub Iran 2003;17(3):197–201.
Walther FJ, Ramaekers LH. The ponderal index as a measure of the nutritional status at birth and its relation to some aspects of neonatal morbidity. J Perinat Med 1982;10(1):42–47. DOI: 10.1515/jpme.1982.10.1.42.
Landmann E, Reiss I, Gortner L, et al. Ponderal index for discrimination between symmetric and asymmetric growth restriction: percentiles for neonates from 30 weeks to 43 weeks of gestation. J Matern Fetal Neonat Med 2006;19(3):157–160. DOI: 10.1080/14767050600624786.
Hoffman C, Galan HL. Assessing the ‘at-risk’ fetus: Doppler ultrasound. Curr Opin Obstet Gynaecol 2009;21(2):161–166. DOI: 10.1097/GCO.0b013e3283292468.
