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Symphysis Fundus Measurements used with a novel Statistical Method for detection of Intrauterine Growth Retardation; a Clinical Evaluation.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. (Obstetrik)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. (Obstetrik)
Nordic School of Public Health, Göteborg.
E Street Statistics, Mölndal, Sweden.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Objective: The statistical method of Shiryaev-Roberts (SR method), using altered growth speed, in combination with symphysis fundus (SF) measurements has theoretically a potential to improve antenatal detection of intrauterine growth restricted (IUGR) fetuses. The main objective of the present study was to compare the ability of the SR method and the SF method (SF measurements compared with a population based reference curve) to identify IUGR and small for gestational age (SGA) fetuses.

Design: A longitudinal study design.

Setting: Pregnant women from 27 primary antenatal care centres in 4 counties.

Population: One thousand eight hundred and eighty eight women with singleton ultrasound dated pregnancies.

Methods: Weekly self-administered SF measurements from gestational week 25 until delivery were analysed according to the SR method. Neonatal morbidity was used as a proxy for IUGR. SGA was defined as a birth weight < -2 standard deviations (SD) or < 10th percentile. Sensitivity for neonatal morbidity and SGA were assessed for alarms given for 5 to 30 % of the study population according to the SR-method and compared with the SF method.

Main outcome measures: Respiratory distress, hypoglycaemia, Apgar < 7 at 5 min, pH < 7.01 in the umbilical artery, neonatal care, preterm delivery, operative delivery for fetal distress, SGA and any neonatal morbidity.

Results: SF measurements from 1122 pregnant women were evaluated. For the SR method sensitivity for neonatal morbidity was between 6.0 and 36.4 %, for SGA (< -2 SD) 36.8 %, and for SGA (< 10th percentile) 20.9 %. The SF method had a sensitivity between 6.0 and 13.8% for neonatal morbidity, for SGA (< -2 SD) 52.3 % and for SGA (< 10th percentile) 28.6 %. Neonates classified as SGA (< -2SD and < 10th percentile) had increased morbidity. Neonates suspected to be SGA before delivery by the SF method had lower morbidity than those not suspected.

Conclusions: The SR method was not found to improve detection of fetuses with increased morbidity or SGA neonates in this study. SGA neonates defined as < – 2 SD or < 10th percentile have increased neonatal morbidity.

Keyword [en]
symphysis-fundus measurements, self-administered, intrauterine growth retardation (IUGR), small for gestational age (SGA), relative growth, fetal growth
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
URN: urn:nbn:se:uu:diva-122244OAI: oai:DiVA.org:uu-122244DiVA: diva2:309552
Projects
Symphysis Fundus Measurements for Detection of Intrauterine Growth Retardationtion
Available from: 2010-04-09 Created: 2010-04-07 Last updated: 2010-04-09Bibliographically approved
In thesis
1. Symphysis Fundus Measurements for Detection of Intrauterine Growth Retardation
Open this publication in new window or tab >>Symphysis Fundus Measurements for Detection of Intrauterine Growth Retardation
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

A case-control study was performed to evaluate the Swedish population-based symphysis fundus (SF) reference curves. The study included 242 small for gestational age (SGA) neonates (169 term and 73 preterm infants) as cases and 296 non-SGA infants as controls. Two Swedish SF curves were evaluated. In term pregnancies they showed a sensitivity of 32 % and 51 % and a specificity of 90 % and 83 %, respectively, at a cut-off level of < - 2 SD from the mean according to the SF reference curve. The sensitivity for SGA was higher in preterm pregnancies (49 % and 58 %, respectively) and the first alarm below – 2 SD was noted before 32 weeks in 37 % and 43 % of the preterm pregnancies, respectively. (Study I)

A study of self-administered SF measurements was designed to achieve more regular and frequent SF measurements. Thirty-three women with singleton, ultrasound dated pregnancies performed SF measurements on average 14 weeks from gestational week 20 to 25 until delivery. Self-administered SF measurements were higher and had higher variance than midwives’ measurements. Four consecutive SF measurements on each occasion can compensate for higher variance. Reliable self-administered SF measurements can be obtained. (Study II)

Self-administered SF measurements from 191 women were used to construct absolute and relative SF growth references. The influence of fetal sex, maternal obesity and parity was assessed in regression models. The lnSF growth was statistically influenced by maternal obesity, and a borderline significance was recorded for fetal sex and parity. Statistical analysis and graphical displays show no evidence that the relative lnSF growth should be dependent on these variables. (Study III)

To improve detection of infants with intrauterine growth restriction (IUGR) rather than SGA a new statistical model (the SR method) was used. The SR method was evaluated with SF measurements from 1122 pregnant women. The sensitivity for neonatal morbidity and SGA was low, between 6 and 36 % for SGA (< -2SD). Neonates classified as SGA (< -2SD and < 10th percentile) had increased morbidity compared with the total study group. Neonates suspected to be SGA before delivery by the population-based SF measurement method had lower morbidity than those not suspected. The SR method was found not to improve detection of fetuses with increased morbidity or SGA neonates in this study. Better screening methods to detect IUGR and SGA prior to delivery are needed. (Study IV)

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 52 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 555
Keyword
symphysis-fundus measurements, small for gestational age, intrauterine growth retardation, fetal growth, self-administered, relative growth, screening method, statistical surveillance, fetal surveillance
Identifiers
urn:nbn:se:uu:diva-122256 (URN)978-91-554-7790-5 (ISBN)
Public defence
2010-05-21, Rosénsalen, Ingång 95-96, Akademiska sjukhuset, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2010-04-29 Created: 2010-04-07 Last updated: 2010-04-29Bibliographically approved

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