Obstet Gynecol Sci.  2021 May;64(3):248-256. 10.5468/ogs.20267.

Detection of small for gestational age in preterm prelabor rupture of membranes by Hadlock versus the Fetal Medicine Foundation growth charts

• Duncan J
• Leavitt K
• Duncan K
• Vilchez G

• KMID: 2515976
• DOI: http://doi.org/10.5468/ogs.20267

Abstract

Objective
The primary outcome was to compare the diagnostic accuracy of neonatal small for gestational age (SGA) by the Hadlock and Fetal Medicine Foundation (FMF) charts in our cohort, followed by the ability to predict composite severe neonatal outcomes (SNO) in pregnancies with preterm prelabor rupture of membranes (PPROM).
Methods
This study was a secondary analysis of a prospective cohort of pregnancies with PPROM from 2015 to 2018, from 23 to 36 completed weeks of gestation. Sensitivity, specificity, and positive and negative predictive values for the primary and secondary outcomes of the Hadlock and FMF fetal charts were calculated. The discriminatory ability of each chart was compared using the area under the receiver’s operating curves of clinical characteristics.
Results
Of the 106 women who met the inclusion criteria, 48 (45%) were screened positive using the FMF fetal growth chart and 22 (21%) were screened positive using the Hadlock chart. SGA was diagnosed in 12 infants (11%). Both fetal growth charts had comparable diagnostic accuracies and were statistically significant predictors of SGA (Hadlock: area under the receiver operating characteristic curves [AUC], 0.76, risk ratio [RR], 7.6, 95% confidence interval [CI], 2.5-23; and FMF: AUC, 0.76 RR, 13.3 95%CI 1.8-99.3). Both growth standards were poor predictors of SNO.
Conclusion
The Hadlock and FMF fetal growth charts have a similar accuracy to predict SGA in pregnancies complicated by PPROM. The FMF fetal growth chart may result in a 2-fold increase in positive screens, potentially increasing fetal surveillance.

Keyword

Fetal growth restriction; Preterm prelabor rupture of membranes

Figure

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  Fig. 1 Study population. PPROM, preterm prelabor rupture of membranes; EFW, estimated fetal weight.

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  Fig. 2 Area under the receiver operating characteristics (ROC) curves for the prediction of small for gestational age by fetal growth restriction Fetal Medicine Foundation (FGR FMF) and the Hadlock fetal growth chart (FGR Hadlock).

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  Fig. 3 Area under the receiver operating characteristics (ROC) curves for the prediction of severe neonatal outcomes by fetal growth restriction Fetal Medicine Foundation (FGR FMF) and the Hadlock fetal growth chart (FGR Hadlock).

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