Ten‐year experience of protocol‐based management of small‐for‐gestational‐age fetuses: perinatal outcome in late‐pregnancy cases diagnosed after 32 weeks
Open accessAbstract
Objective: To report our 10‐year experience of protocol‐based management of small‐for‐gestational‐age (SGA) fetuses, based on standardized clinical and Doppler criteria, in late‐pregnancy cases. Methods: A retrospective cohort was constructed of consecutive singleton pregnancies referred for late‐onset (> 32 weeks) SGA (defined as estimated fetal weight (EFW) < 10 th centile) that were classified as fetal growth restriction (FGR) or low‐risk SGA, based on the severity of smallness (EFW < 3 rd centile) and the presence of Doppler abnormalities (uterine artery pulsatility index (UtA‐PI) ≥ 95 th centile or cerebroplacental ratio (CPR) < 5 th centile). Low‐risk SGA pregnancies were followed at 2‐week intervals and delivered electively at 40 weeks. FGR pregnancies were followed at 1‐week intervals, or more frequently if there were signs of fetal deterioration, and were delivered electively after 37 + 0 weeks' gestation. The occurrence of stillbirth and composite adverse outcome (CAO; defined as neonatal death, metabolic acidosis, need for endotracheal intubation or need for admission to the neonatal intensive care unit) was analyzed in low‐risk SGA and FGR pregnancies. Results: A total of 1197 pregnancies with EFW < 10 th centile were identified and classified at diagnosis as low‐risk SGA ( n = 619; 51.7%) or FGR ( n = 578; 48.3%). Of these, 160 were delivered before 37 weeks' gestation; for obstetric reasons in 93 (58.1%) cases, severe pre‐eclampsia in 33 (20.6%), FGR with severe hypoxia in 47 (29.4%) and stillbirth in four (2.5%) (indications are non‐exclusive). During follow‐up, 52/574 (9.1%) low‐risk SGA pregnancies were reclassified as FGR, whereas 22/463 (4.8%) FGR pregnancies were reclassified as low‐risk SGA. Overall, there were no stillbirths in the low‐risk SGA group and four in the FGR group, all of which occurred before 37 weeks. There were no instances of neonatal death in pregnancies delivered ≥ 37 weeks. The risk of CAO was higher in those meeting antenatal criteria for FGR at 37 weeks than in those classified as low‐risk SGA (32/493 (6.5%) vs 15/544 (2.8%); odds ratio, 2.5 (95% CI, 1.3–4.6)). In FGR pregnancies, the adjusted odds ratio (95% CI) for CAO was 6.3 (1.8–21.1) in those with EFW < 3 rd centile, while it was 3.2 (1.5–6.8) and 4.2 (1.9–8.9) in those with UtA‐PI ≥ 95 th centile and CPR < 5 th centile, respectively, as compared to FGR pregnancies without each of these criteria. Conclusion: Protocol‐based risk stratification with different management and monitoring schemes for late pregnancy with a suspected SGA baby, based on clinical and Doppler criteria, enables identification and tailored assessment of high‐risk FGR, while allowing expectant management with safe perinatal outcome for low‐risk SGA fetuses. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Identifying FGR risk at 20-24 weeks - before overt restriction - creates opportunities for proactive management.
“Identifying FGR risk at 20–24 weeks – before overt restriction – creates opportunities for proactive management.2,13,31,32”
From Early detection of severe fetal growth restriction using multimodal deep learning based on ultrasound and prenatal biomarkers (2026) · cites this paper as [31]
The Study subjects section (page not available) says the cohort comprised suspected SGA pregnancies diagnosed after 32 weeks. The Management section describes monitoring and delivery plans based on FGR risk, supporting the management point, but the paper does not establish that identifying risk at 20–24 weeks, before overt restriction, creates that opportunity. (LLM, conf=0.86)
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Cites
von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., Vandenbroucke, J. P., & Initiative, F. T. S. (2007) · PLoS Medicine · doi:10.1371/journal.pmed.0040296 · Cited by 23,020 · see citing works
von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., Vandenbroucke, J. P., & Initiative, F. T. S. (2007) · Annals of Internal Medicine · doi:10.7326/0003-4819-147-8-200710160-00010 · Cited by 17,796 · see citing works
von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., & Vandenbroucke, J. P. (2014) · International Journal of Surgery · doi:10.1016/j.ijsu.2014.07.013 · Cited by 9,909 · see citing works
Estimation of fetal weight with the use of head, body, and femur measurements—A prospective study
Hadlock, F. P., Harrist, R. B., Sharman, R. S., Deter, R. L., & Park, S. K. (1985) · American Journal of Obstetrics and Gynecology · doi:10.1016/0002-9378(85)90298-4 · Cited by 2,682 · see citing works
Consensus definition of fetal growth restriction: a Delphi procedure: Consensus definition of FGR
Gordijn, S. J., Beune, I. M., Thilaganathan, B., Papageorghiou, A., Baschat, A. A., Baker, P. N., Silver, R. M., Wynia, K., & Ganzevoort, W. (2016) · Ultrasound in Obstetrics & Gynecology · doi:10.1002/uog.15884 · Cited by 1,638 · see citing works
Tranquilli, A. L., Dekker, G., Magee, L. A., Roberts, J. M., Sibai, B. M., Steyn, W., Zeeman, G. G., & Brown, M. A. (2014) · Pregnancy Hypertension · doi:10.1016/j.preghy.2014.02.001 · Cited by 1,419 · see citing works
A CRITICAL EVALUATION OF SONAR “CROWN‐RUMP LENGTH” MEASUREMENTS
Robinson, H. P., & Fleming, J. E. E. (1975) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.1975.tb00710.x · Cited by 1,413 · see citing works
Maternal and fetal risk factors for stillbirth: population based study
Gardosi, J., Madurasinghe, V., Williams, M., Malik, A., & Francis, A. (2013) · BMJ · doi:10.1136/bmj.f108 · Cited by 941 · see citing works
ISUOG Practice Guidelines: ultrasound assessment of fetal biometry and growth
Salomon, L. J., Alfirevic, Z., Da Silva Costa, F., Deter, R. L., Figueras, F., Ghi, T., Glanc, P., Khalil, A., Lee, W., Napolitano, R., et al. (2019) · Ultrasound in Obstetrics & Gynecology · doi:10.1002/uog.20272 · Cited by 704 · see citing works
Self-citationSovio, U., White, I. R., Dacey, A., Pasupathy, D., & Smith, G. C. S. (2015) · The Lancet · doi:10.1016/s0140-6736(15)00131-2 · Cited by 610 · see citing works
Reference ranges for uterine artery mean pulsatility index at 11–41 weeks of gestation
Gómez, O., Figueras, F., Fernández, S., Bennasar, M., Martínez, J. M., Puerto, B., & Gratacós, E. (2008) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.5315 · Cited by 595 · see citing works
Self-citationBoers, K. E., Vijgen, S. M. C., Bijlenga, D., van der Post, J., Bekedam, D. J., Kwee, A., van der Salm, P. C. M., van Pampus, M. G., Spaanderman, M. E. A., de Boer, K., et al. (2010) · BMJ · doi:10.1136/bmj.c7087 · Cited by 536 · see citing works
The cerebroplacental Doppler ratio revisited
Baschat, A., & Gembruch, U. (2003) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.20 · Cited by 505 · see citing works
McCowan, L. M., Figueras, F., & Anderson, N. H. (2018) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2017.12.004 · Cited by 451 · see citing works
Self-citationISUOG Practice Guidelines: use of Doppler ultrasonography in obstetrics
Bhide, A., Acharya, G., Bilardo, C. M., Brezinka, C., Cafici, D., Hernandez‐Andrade, E. A., Kalache, K. D., Kingdom, J. C., Kiserud, T., Lee, W., et al. (2013) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.12371 · Cited by 444 · see citing works
Mackay, D., Smith, G. C. S., Dobbie, R., & Pell, J. (2010) · PLoS Medicine · doi:10.1371/journal.pmed.1000289 · Cited by 436 · see citing works
Customized birthweight standards for a Spanish population
Figueras, F., Meler, E., Iraola, A., Eixarch, E., Coll, O., Figueras, J., Francis, A., Gratacós, E., & Gardosi, J. O. (2007) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2006.12.015 · Cited by 387 · see citing works
Self-citationProgression of Doppler abnormalities in intrauterine growth restriction
Turan, O. M., Turan, S., Gungor, S., Berg, C., Moyano, D., Gembruch, U., Nicolaides, K. H., Harman, C. R., & Baschat, A. A. (2008) · Ultrasound in Obstetrics & Gynecology · doi:10.1002/uog.5386 · Cited by 353 · see citing works
Reference ranges for fetal venous and atrioventricular blood flow parameters
Hecher, K., Campbell, S. C., Snijders, R. J. M., & Nicolaides, K. H. (1994) · Ultrasound in Obstetrics and Gynecology · doi:10.1046/j.1469-0705.1994.04050381.x · Cited by 315 · see citing works
The risk of intrauterine fetal death in the small-for-gestational-age fetus
Pilliod, R. A., Cheng, Y. W., Snowden, J. M., Doss, A. E., & Caughey, A. B. (2012) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2012.06.039 · Cited by 201 · see citing works
Conde‐Agudelo, A., Villar, J., Kennedy, S., & Papageorghiou, A. T. (2018) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.19117 · Cited by 171 · see citing works
Savchev, S., Figueras, F., Cruz‐Martinez, R., Illa, M., Botet, F., & Gratacos, E. (2012) · Ultrasound in Obstetrics & Gynecology · doi:10.1002/uog.10150 · Cited by 160 · see citing works
Self-citationFigueras, F., Savchev, S., Triunfo, S., Crovetto, F., & Gratacós, E. (2014) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.14714 · Cited by 152 · see citing works
Self-citationStage-based approach to the management of fetal growth restriction
Figueras, F., & Gratacos, E. (2014) · Prenatal Diagnosis · doi:10.1002/pd.4412 · Cited by 140 · see citing works
Self-citationPlanning management and delivery of the growth-restricted fetus
Baschat, A. (2018) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2018.02.009 · Cited by 113 · see citing works
van Wyk, L., Boers, K. E., van der Post, J., van Pampus, M. G., Leemhuis, A. G., van Baar, A. L., Spaanderdam, M. E. A., Becker, J., Kwee, A., Duvekot, J. J., et al. (2012) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2012.02.003 · Cited by 103 · see citing works
McCowan, L. M. E., Harding, J. E., Roberts, A. B., Barker, S. E., Ford, C., & Stewart, A. W. (2000) · American Journal of Obstetrics and Gynecology · doi:10.1016/s0002-9378(00)70494-7 · Cited by 101 · see citing works
ISUOG Practice Guidelines: Use of Doppler Ultrasonography in Obstetrics
Patnaik, S. (2018) · Jaypee Brothers Medical Publishers (P) Ltd. eBooks · doi:10.5005/jp/books/18023_15 · Cited by 100 · see citing works
Boers, K. E., van Wyk, L., van der Post, J., Kwee, A., van Pampus, M. G., Spaanderdam, M. E. A., Duvekot, J. J., Bremer, H. A., Delemarre, F. M. C., Bloemenkamp, K. W. M., et al. (2012) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2012.01.015 · Cited by 78 · see citing works
Heidweiller‐Schreurs, C. A. V., van Osch, I., Heymans, M. W., Ganzevoort, W., Schoonmade, L. J., Bax, C. J., Mol, B. W., de Groot, C. J. M., Bossuyt, P. M., de Boer, M. A., et al. (2020) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.16287 · Cited by 72 · see citing works
Martinez-Portilla, R. J., Caradeux, J., Meler, E., Lip‐Sosa, D. L., Sotiriadis, A., & Figueras, F. (2019) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.21940 · Cited by 50 · see citing works
Self-citationSmall‐for‐gestational‐age babies after 37 weeks: impact study of risk‐stratification protocol
Veglia, M., Cavallaro, A., Papageorghiou, A. T., Black, R., & Impey, L. W. M. (2017) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.17544 · Cited by 45 · see citing works
Caradeux, J., Eixarch, E., Mazarico, E., Basuki, T. R., Gratacós, E., & Figueras, F. (2017) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.18824 · Cited by 32 · see citing works
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Wang, J., Wang, J., Peng, Y., Hou, F., Zhang, X., & Jin, H. (2026) · Annals of Medicine · doi:10.1080/07853890.2026.2688297
“2,13,31,32 This aligns with emerging paradigms in perinatal medicine emphasizing prediction, prevention, and personalization.”
- Authors
- Meler, E., Mazarico, E., Eixarch, E., Gonzalez, A., Peguero, A., Martinez, J., Boada, D., Vellvé, K., Gomez‐Roig, M. D., Gratacós, E., & Figueras, F.
- Affiliations
- Hospital Sant Joan de Déu Barcelona (ES)
- Barcelona Center for Maternal–Fetal and Neonatal Medicine Hospital Clínic and Hospital Sant Joan de Déu, IDIBAPS, University of Barcelona Barcelona Spain
- Corresponding author
- Figueras, F.
- ORCID
- Venue
- Ultrasound in Obstetrics & Gynecology
- Publisher
- Wiley
- Published
- 2021-01
- Volume
- 57
- Issue
- 1
- Pages
- 62-69
- ISSN
- 0960-7692 (ISSN-L)
- 1469-0705
- OpenAlex
- W3095052076
- Cited by
- 36
- References
- 33
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 4 · 2023: 7 · 2022: 6 · 2021: 6
- FWCI
- 2.91
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Ultrasound in Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Departament de Salut, Generalitat de Catalunya (SLT008/18/00156)
- Instituto de Salud Carlos III (PI14/00226, PIE15/00027, PI16/00861, PI18/00073)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Keywords
- small-for-gestational-age fetuses, fetal growth restriction, late-onset fetal growth restriction, uterine artery pulsatility index, cerebroplacental ratio, Doppler ultrasound, elective delivery, perinatal outcomes, stillbirth, neonatal intensive care admission, preeclampsia, hypoxia, estimated fetal weight, late pregnancy
- MeSH terms
- Adult, Female, Fetal Growth Retardation, Gestational Age, Humans, Infant, Newborn, Infant, Small for Gestational Age, Pregnancy, Pregnancy Outcome, Pregnancy Trimester, Third, Pulsatile Flow, Retrospective Studies, Umbilical Arteries, Risk Assessment, Ultrasonography, Doppler, Middle Cerebral Artery
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