Prediction of adverse perinatal outcome at term in small-for-gestational age fetuses: comparison of growth velocity vs. customized assessment

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Abstract
To explore the ability of growth velocity and customized standards of fetal weight to predict adverse outcomes in small fetuses delivered at term. We evaluated a cohort of 86 consecutive singletons suspected to be small for gestational age during the third trimester (estimated fetal weight <10(th) centile), who had normal umbilical artery Doppler and ultimately delivered at term. Conditional growth velocity and customized fetal growth were compared for the prediction of adverse outcome. Overall, customized growth assessment showed better sensitivity than growth velocity assessment (57.1% vs. 42.9% for a 10(th) centile cut-off) for the prediction of adverse outcome, but with comparable specificity. The odds of having an adverse outcome for women with a positive test compared with women with a negative test were 1.54 and 3.22 for the 10(th) centile growth velocity and customized definitions, respectively. The area under the curve for the prediction of adverse outcome was larger for customized than for growth velocity standards (0.65 vs. 0.59), albeit without statistical significance. Our study suggests that customized growth assessment may have better accuracy in predicting adverse perinatal outcome than growth velocity in small fetuses with normal umbilical Doppler delivered at term.