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Cited by 549Pregnancy and preeclampsia studiesBirth, Development, and HealthPrenatal Screening and Diagnostics

Society for Maternal-Fetal Medicine Consult Series #52: Diagnosis and management of fetal growth restriction

Open access
Martins, Juliana Gevaerd, Biggio, Joseph R., Abuhamad, Alfred·2020·American Journal of Obstetrics and Gynecology
DOI 10.1016/j.ajog.2020.05.010
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Abstract

Society for Maternal-Fetal Medicine Consult Series #52: Diagnosis and management of fetal growth restriction. Fetal growth restriction is associated with perinatal morbidity and mortality.

Integrity signals

Registry

Crossref · 10.1016/j.ajog.2020.05.010

Cites

208 of 208 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

60 of 155 cited sources checked · 24 supported · 2 flagged · accuracy not yet measured

  • Premisecitation

    The finding of low-dose aspirin benefit was not confirmed in the ASPRE trial, which was primarily designed for preterm preeclampsia prevention.

    “However, this finding was not confirmed in the Aspirin for Evidence-Based Preeclampsia Prevention (ASPRE) trial, which was primarily designed for preterm preeclampsia prevention.74,75”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [74] Rolnik, 2017, Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia, N Engl J Med source

      The Primary Outcome section reports significantly less preterm preeclampsia with aspirin than placebo (1.6% versus 4.3%; P = 0.004), contrary to the claim that the trial did not confirm an aspirin benefit. The Discussion confirms that preterm preeclampsia was the trial’s primary outcome; it notes no significant differences for other outcomes, but says the trial was not adequately powered for them. (LLM, conf=0.89)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [75] Groom, 2018, The role of aspirin, heparin, and other interventions in the prevention and treatment of fetal growth restriction, Am J Obstet Gynecol source
  • Interpretationcitation

    The available evidence does not indicate improved accuracy of CPR over umbilical artery Doppler.

    “The available evidence does not indicate improved accuracy of CPR over umbilical artery Doppler, and clinical trials are needed to evaluate the effectiveness of CPR in guiding clinical management, especially in late-onset FGR, before its use in routine surveillance of pregnancies with FGR can be recommended.139”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [139] Vollgraff Heidweiller-Schreurs, 2018, Prognostic accuracy of cerebroplacental ratio and middle cerebral artery Doppler for adverse perinatal outcome: systematic review and meta-analysis, Ultrasound Obstet Gynecol source

      The Results (Direct comparisons) and Discussion (Summary of main results) report that CPR was significantly more accurate than umbilical artery Doppler for composite adverse outcome and emergency delivery for fetal distress, though accuracy was similar for other outcomes. The Conclusion also says CPR can improve accuracy. The paper does call for clinical trials before using CPR to guide management, but that does not support the claim that the available evidence indicates no accuracy improvement. (LLM, conf=0.89)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
  • Premisecitation

    Fetal growth restriction can contribute to cardiac remodeling, leading to cardiovascular dysfunction that can persist into childhood and adolescence.

    “It also can contribute to cardiac remodeling, leading to cardiovascular dysfunction that can persist into childhood and adolescence.13,14”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [13] Cruz-Lemini, 2016, Fetal cardiovascular remodeling persists at 6 months in infants with intrauterine growth restriction, Ultrasound Obstet Gynecol source

      The Introduction and Discussion report that intrauterine growth restriction is associated with fetal cardiovascular remodeling and dysfunction, and the study found that the pattern persisted at six months. The Introduction also discusses cardiovascular changes in children and young adults, but the Strengths and limitations section says persistence of this study’s findings in the long term remains to be established. It therefore does not establish that the cardiac dysfunction persists into adolescence. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [14] Crispi, 2010, Fetal growth restriction results in remodeled and less efficient hearts in children, Circulation source
  • Premisecitation

    Perinatal outcomes in fetal growth restriction are largely dependent on severity, with the worst outcomes in fetuses with estimated fetal weight less than the third percentile or fetal Doppler abnormalities.

    “Perinatal outcomes are largely dependent on the severity of FGR, with the worst outcomes noted in fetuses with estimated fetal weights (EFWs) at less than the third percentile or in association with fetal Doppler abnormalities.5,10”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [5] Unterscheider, 2014, Fetal growth restriction and the risk of perinatal mortality-case studies from the multicentre PORTO study, BMC Pregnancy Childbirth source
    • cites [10] Savchev, 2012, Estimated weight centile as a predictor of perinatal outcome in small-for-gestational-age pregnancies with normal fetal and maternal Doppler indices, Ultrasound Obstet Gynecol source
  • Premisecitation

    Fetal growth restriction can result from a variety of maternal, fetal, and placental conditions.

    “Fetal growth restriction (FGR) can result from a variety of maternal, fetal, and placental conditions. 1”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [1] Swanson, 2015, Animal models of fetal growth restriction: Considerations for translational medicine, Placenta source
  • May combine two claims. 32
  • Classified as probably not a substantial claim. 5

  • May combine two claims.

    Premisecitation

    Suboptimal perfusion of the maternal placental circulation is the most common cause of fetal growth restriction and accounts for 25%-30% of all cases.

    “Suboptimal perfusion of the maternal placental circulation is the most common cause of FGR and accounts for 25e30% of all cases.2,3”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [2] Bamfo, 2011, Diagnosis and management of fetal growth restriction, J Pregnancy source

      Section 2.1 (Causes; page unavailable) says maternal vascular disease and thrombophilia can cause uteroplacental hypoperfusion that impairs fetal growth. Section 2.2 also discusses inadequate placentation in pregnancies with FGR. Neither section establishes that suboptimal maternal placental perfusion is the most common cause or accounts for 25–30% of all FGR cases; the 20–30% figure in section 2.1 concerns dichorionic twin pregnancies. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [3] Resnik, 2002, Intrauterine growth restriction, Obstet Gynecol source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Chromosomal disorders and congenital malformations are responsible for approximately 20% of fetal growth restriction cases.

    “Chromosomal disorders and congenital malformations are responsible for approximately 20% of FGR cases.2,3”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [2] Bamfo, 2011, Diagnosis and management of fetal growth restriction, J Pregnancy source

      Section 2.1 (Causes; page unavailable) identifies aneuploidy and fetal malformations as less-common fetal causes of FGR. It does not say they account for approximately 20% of cases. Its figure of over 20% refers instead to confined placental mosaicism among fetuses with idiopathic FGR. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [3] Resnik, 2002, Intrauterine growth restriction, Obstet Gynecol source

  • May combine two claims.

    Premisecitation

    Maternal hypertensive disease is common in early-onset fetal growth restriction and plays an important role in pregnancy outcomes.

    “Maternal hypertensive disease is common in early-onset FGR and plays an important role in pregnancy outcomes.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [80] Lees, 2013, Perinatal morbidity and mortality in early-onset fetal growth restriction: cohort outcomes of the trial of randomized umbilical and fetal flow in Europe (TRUFFLE), Ultrasound Obstet Gynecol source

  • May combine two claims.

    Premisecitation

    In late-onset fetal growth restriction, cardiovascular adaptation is typically limited to the cerebral circulation and is commonly associated with normal Doppler of the umbilical arteries.

    “In contrast, cardiovascular adaptation of late-onset FGR is typically limited to the cerebral circulation and is commonly associated with normal Doppler of the umbilical arteries.57,60,61”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [57] Parra-Saavedra, 2014, Neurodevelopmental outcomes of near-term small-for-gestational-age infants with and without signs of placental underperfusion, Placenta source
    • cites [60] Figueras, 2008, Small-for-gestational-age fetuses with normal umbilical artery Doppler have suboptimal perinatal and neurodevelopmental outcome, Eur J Obstet Gynecol Reprod Biol source
    • cites [61] Severi, 2002, Uterine and fetal cerebral Doppler predict the outcome of third-trimester small-for-gestational age fetuses with normal umbilical artery Doppler, Ultrasound Obstet Gynecol source

      The Introduction (page unavailable) describes cerebral blood-flow redistribution as a fetal response to mild hypoxemia, and the Discussion (page unavailable) examines abnormal middle cerebral artery Doppler in third-trimester small-for-gestational-age fetuses with normal umbilical artery Doppler. But normal umbilical Doppler was an inclusion criterion, so the study does not establish that it is common across late-onset growth restriction or that cardiovascular adaptation is typically limited to the cerebral circulation. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Late-onset fetal growth restriction represents approximately 70%-80% of fetal growth restriction cases and is typically milder in presentation.

    “Late-onset FGR represents approximately 70%e80% of FGR cases and is typically milder in presentation.55,56”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [55] Dall'Asta, 2017, Early onset fetal growth restriction, Matern Health Neonatol Perinatol source
    • cites [56] Figueras, 2018, Diagnosis and surveillance of late-onset fetal growth restriction, Am J Obstet Gynecol source

  • May combine two claims.

    Premisecitation

    Pregnant women with hypertension had a significantly shorter median interval from study enrollment to delivery, and newborns of mothers with hypertension were delivered at an earlier gestational age and had lower birthweights.

    “Pregnant women with hypertension had a significantly shorter median interval from study enrollment to delivery, and newborns of mothers with hypertension were delivered at an earlier gestational age and had lower birthweights.80”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [80] Lees, 2013, Perinatal morbidity and mortality in early-onset fetal growth restriction: cohort outcomes of the trial of randomized umbilical and fetal flow in Europe (TRUFFLE), Ultrasound Obstet Gynecol source

  • May combine two claims.

    Premisecitation

    In a large retrospective cohort of more than 3 million singleton pregnancies, the risk of stillbirth at birthweights of less than the 3rd percentile was increased approximately 3-fold over the 3rd to 5th percentile group at nearly all gestational ages, and there was an increased risk of 4-fold to 7-fold over the 5th to 10th percentile group.

    “In a large retrospective cohort of more than 3 million singleton pregnancies, the risk of stillbirth at birthweights of less than the 3rd percentile was increased approximately 3-fold over the 3rd to 5th percentile group at nearly all gestational ages, and there was an increased risk of 4-fold to 7-fold over the 5th to 10th percentile group.63”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [63] Pilliod, 2012, The risk of intrauterine fetal death in the small-for-gestational-age fetus, Am J Obstet Gynecol source

  • May combine two claims.

    Premisecitation

    In TRUFFLE, maternal hypertension was present in 50% of pregnancies during the study and 70% of pregnancies at the time of delivery.

    “In TRUFFLE, maternal hypertension was present in 50% of pregnancies during the study and 70% of pregnancies at the time of delivery.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [80] Lees, 2013, Perinatal morbidity and mortality in early-onset fetal growth restriction: cohort outcomes of the trial of randomized umbilical and fetal flow in Europe (TRUFFLE), Ultrasound Obstet Gynecol source

      The Results (page unavailable in our copy) report that 368 women (73%) had a hypertensive condition at delivery, supporting the claim's approximate 70%. They do not report 50% during the study; instead, they say the proportion with a gestational hypertensive condition increased by 13% between study entry and delivery. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The pulsatility index, resistance index, or systolic-to-diastolic ratio can be used for quantification of the Doppler waveform in the umbilical artery, although recent studies have generally used either the pulsatility index or resistance index.

    “The pulsatility index (PI), resistance index (RI), or systolicto-diastolic (S/D) ratio can be used for quantification of the Doppler waveform in the umbilical artery, although recent studies have generally used either the PI or RI.5,16,28,30,80,83”
    Quote in the paperNot a substantial claim3 of 6 sources checked
    • cites [5] Unterscheider, 2014, Fetal growth restriction and the risk of perinatal mortality-case studies from the multicentre PORTO study, BMC Pregnancy Childbirth source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [16] Lees, 2015, 2 year neurodevelopmental and intermediate perinatal outcomes in infants with very preterm fetal growth restriction (TRUFFLE): a randomised trial, Lancet source
    • cites [28] Gordijn, 2016, Consensus definition of fetal growth restriction: a Delphi procedure, Ultrasound Obstet Gynecol source
    • cites [30] Unterscheider, 2013, Optimizing the definition of intrauterine growth restriction: the multicenter prospective PORTO Study, Am J Obstet Gynecol source
    • cites [80] Lees, 2013, Perinatal morbidity and mortality in early-onset fetal growth restriction: cohort outcomes of the trial of randomized umbilical and fetal flow in Europe (TRUFFLE), Ultrasound Obstet Gynecol source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [83] Baschat, 2007, Predictors of neonatal outcome in early-onset placental dysfunction, Obstet Gynecol source

      Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Incorporation of umbilical artery Doppler evaluation in the management of high-risk pregnancies significantly reduces the risk of perinatal death, induction of labor, and cesarean delivery.

    “Incorporation of umbilical artery Doppler evaluation in the management of high-risk pregnancies has been shown to significantly reduce the risk of perinatal death, induction of labor, and cesarean delivery.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [96] McCowan, 2000, A pilot randomized controlled trial of two regimens of fetal surveillance for small-for-gestational-age fetuses with normal results of umbilical artery doppler velocimetry, Am J Obstet Gynecol source
    • cites [97] Alfirevic, 2017, Fetal and umbilical Doppler ultrasound in high-risk pregnancies, Cochrane Database Syst Rev source
    • Rests on an assumption: An abnormal umbilical artery Doppler waveform reflects the presence of placental insufficiency and can help differentiate the growth-restricted fetus from the constitutionally small fetus.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Protocols for umbilical artery Doppler in FGR surveillance vary from weekly to a 2-to 4-week interval.

    “Protocols vary from weekly umbilical artery Doppler to a 2-to 4-week interval.24,108”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [24] McCowan, 2018, Evidence-based national guidelines for the management of suspected fetal growth restriction: comparison, consensus, and controversy, Am J Obstet Gynecol source

      Table 4 (Conclusions; page not supplied) shows that recommended umbilical artery Doppler intervals vary, including weekly and every two weeks, depending on the guideline and Doppler findings. The Results section gives a 2–4-week interval for ongoing growth scans, not umbilical artery Doppler, so the claimed four-week Doppler interval is unsupported. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [108] Turan, 2008, Progression of Doppler abnormalities in intrauterine growth restriction, Ultrasound Obstet Gynecol source

      The Discussion recommends weekly umbilical artery Doppler examinations after IUGR is diagnosed. It does not recommend a 2-to-4-week Doppler interval; its reference to the next two weeks concerns whether abnormalities develop, not how often to test. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    A large systematic review and meta-analysis on the prognostic accuracy of CPR and middle cerebral artery Doppler for adverse perinatal outcomes in FGR revealed few high-quality studies and reported large variations in sensitivity and specificity.

    “However, a large systematic review and metaanalysis on the prognostic accuracy of CPR and middle cerebral artery Doppler for adverse perinatal outcomes in FGR revealed few high-quality studies and reported large variations in sensitivity and specificity.139”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [139] Vollgraff Heidweiller-Schreurs, 2018, Prognostic accuracy of cerebroplacental ratio and middle cerebral artery Doppler for adverse perinatal outcome: systematic review and meta-analysis, Ultrasound Obstet Gynecol source

  • May combine two claims.

    Premisecitation

    Intact survival was 0% at 24 weeks, 13% at 25 weeks, and 6%e31% at 26 weeks of gestation.

    “Intact survival was 0% at 24 weeks, 13% at 25 weeks, and 6%e31% at 26 weeks of gestation.159”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [159] Visser, 2014, Fetal growth restriction at the limits of viability, Fetal Diagn Ther source

  • May combine two claims.

    Premisecitation

    Although FGR detection rates >90% have been reported in first- and second-trimester prediction models combining maternal factors, biochemical markers, and uterine artery Doppler, lack of external validation or demonstration of improved pregnancy outcomes limits their clinical applicability.

    “Although FGR detection rates >90% have been reported in firstand second-trimester prediction models that combine maternal factors, biochemical markers, and uterine artery Doppler, lack of external validation or demonstration of improved pregnancy outcomes limits their clinical applicability.145,150,151”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [145] Poon, 2015, Prediction of small-for-gestational-age neonates: screening by biophysical and biochemical markers at 19-24 weeks, Ultrasound Obstet Gynecol source

      Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [150] Karagiannis, 2011, Prediction of small-for-gestation neonates from biophysical and biochemical markers at 11-13 weeks, Fetal Diagn Ther source
    • cites [151] Cruz-Martinez, 2015, Clinical utility of third-trimester uterine artery Doppler in the prediction of brain hemodynamic deterioration and adverse perinatal outcome in small-for-gestational-age fetuses, Ultrasound Obstet Gynecol source

      Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Another systematic review and meta-analysis reported that abdominal circumference and estimated fetal weight performed similarly, and for a 10% fixed false-positive rate, abdominal circumference had higher sensitivity.

    “Another systematic review and meta-analysis reported that AC and EFW performed similarly, and for a 10% fixed false-positive rate, AC had higher sensitivity.33”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] Caradeux, 2019, Diagnostic performance of third-trimester ultrasound for the prediction of late-onset fetal growth restriction: a systematic review and meta-analysis, Am J Obstet Gynecol source

  • May combine two claims.

    Premisecitation

    Fetal growth restriction remains a complex obstetrical problem with disparate published diagnostic criteria, relatively low detection rates, and limited preventative and treatment options.

    “FGR remains a complex obstetrical problem with disparate published diagnostic criteria, relatively low detection rates, and limited preventative and treatment options.22e25”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites 22e25

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Compared with other cutoffs, an abdominal circumference of less than the fifth percentile has significantly lower sensitivity but higher specificity in predicting small for gestational age.

    “Compared with other cutoffs, an AC of less than the fifth percentile has significantly lower sensitivity but higher specificity in predicting SGA.32”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Blue, 2017, Abdominal Circumference Alone versus Estimated Fetal Weight after 24 Weeks to Predict Small or Large for Gestational Age at Birth: A Meta-Analysis, Am J Perinatol source

  • May combine two claims.

    Premisecitation

    Fetuses with fetal growth restriction are not always small for gestational age at birth, and small-for-gestational-age neonates have often not been diagnosed as growth restricted on prenatal ultrasound.

    “Fetuses with FGR are not always SGA at birth, and SGA neonates have often not been diagnosed as growth restricted on prenatal ultrasound.27”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [27] Monier, 2017, Fetal and neonatal outcomes of preterm infants born before 32 weeks of gestation according to antenatal vs postnatal assessments of restricted growth, Am J Obstet Gynecol source

  • May combine two claims.

    Premisecitation

    Studies have shown an association between fetal growth restriction and long-term neurologic impairment, with rates of cognitive and learning disabilities as high as 20%-40% by school age.

    “In addition, studies have shown an association between FGR and long-term neurologic impairment, 15e20 with rates of cognitive and learning disabilities as high as 20%e40% by school age.21”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites 15e20

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [21] Leitner, 2007, Neurodevelopmental outcome of children with intrauterine growth retardation: a longitudinal, 10-year prospective study, J Child Neurol source

  • May combine two claims.

    Premisecitation

    The Hadlock formula classified more infants within 10% of actual birthweight and was more accurate than INTERGROWTH-21st in the overall estimation of weight for fetuses delivered between 22 and 34 weeks of gestation.

    “The Hadlock formula classified more infants within 10% of actual birthweight and was more accurate than the INTERGROWTH-21st in the overall estimation of weight for fetuses delivered between 22 and 34 weeks of gestation.53”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [53] Monier, 2018, Comparison of the Hadlock and INTERGROWTH formulas for calculating estimated fetal weight in a preterm population in France, Am J Obstet Gynecol source

  • May combine two claims.

    Premisecitation

    Early-onset fetal growth restriction is typically more severe, tends to follow an established Doppler pattern of fetal deterioration, is more commonly associated with maternal hypertensive disorders of pregnancy, and shows more significant placental dysfunction than late-onset fetal growth restriction.

    “The clinical spectrum of early-and late-onset FGR also differs; early-onset FGR is typically more severe, tends to follow an established Doppler pattern of fetal deterioration, is more commonly associated with maternal hypertensive disorders of pregnancy, and shows more significant placental dysfunction than late-onset FGR.23,28,54e56”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites 23,28,54e56

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    The Hadlock formula better predicted small for gestational age and composite neonatal morbidity at birth and had a lower ultrasound-to-birthweight percentile discrepancy than the NICHD growth standard.

    “The Hadlock formula better predicted SGA and composite neonatal morbidity at birth and had a lower ultrasound-to-birthweight percentile discrepancy than the NICHD growth standard.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [51] Blue, 2018, Comparing the Hadlock fetal growth standard to the Eunice Kennedy Shriver National Institute of Child Health and Human Development racial/ethnic standard for the prediction of neonatal morbidity and small for gestational age, Am J Obstet Gynecol source

  • May combine two claims.

    Premisecitation

    Unlike early-onset fetal growth restriction, late-onset fetal growth restriction is less likely to be associated with maternal hypertensive disorders and typically has less extensive placental histopathologic findings of underperfusion.

    “Unlike early-onset FGR, late-onset FGR is less likely to be associated with maternal hypertensive disorders and typically has less extensive placental histopathologic findings of underperfusion.57e59”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites 57e59

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    There is no consistent evidence that nutritional and dietary supplements or bed rest prevents fetal growth restriction or reduces the incidence of small-for-gestational-age births.

    “There is no consistent evidence that nutritional and dietary supplements or bed rest prevents FGR or reduces the incidence of SGA births.68e71”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites 68e71

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    In a study of 319 pregnancies, no cases of maternal or congenital infection with toxoplasma, rubella, or herpes were found, whereas 6 (1.8%) fetuses were diagnosed as having congenital cytomegalovirus.

    “The association of maternal infections with FGR was recently evaluated in a study that included 319 pregnancies.No cases of maternal or congenital infection with toxoplasma, rubella, or herpes were found, whereas 6 (1.8%) fetuses were diagnosed as having congenital cytomegalovirus (CMV).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [91] Yamamoto, 2013, Significance of maternal screening for toxoplasmosis, rubella, cytomegalovirus and herpes simplex virus infection in cases of fetal growth restriction, J Obstet Gynaecol Res source

  • May combine two claims.

    Premisecitation

    Waveforms obtained near the placental end of the cord reflect downstream impedance and show higher end-diastolic blood flow velocity than waveforms obtained near the fetal cord insertion.

    “Waveforms obtained near the placental end of the cord reflect downstream impedance and show higher end-diastolic blood flow velocity than waveforms obtained near the fetal cord insertion.95”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [95] Trudinger, 1992, Doppler ultrasonography and fetal well-being

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    In a meta-analysis of 35 studies, abnormal middle cerebral artery Doppler had a low likelihood ratio for prediction of perinatal mortality (LR 1.36 [1.10e1.67]) and adverse perinatal outcome (LR 2.77 [1.93e3.96]).

    “In a meta-analysis of 35 studies, abnormal middle cerebral artery Doppler had a low likelihood ratio (LR) for prediction of perinatal mortality (LR 1.36 [1.10e1.67])and adverse perinatal outcome (LR 2.77 [1.93e3.96]).130”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [130] Morris, 2012, Systematic review and meta-analysis of middle cerebral artery Doppler to predict perinatal wellbeing, Eur J Obstet Gynecol Reprod Biol source

  • May combine two claims.

    Premisecitation

    Longitudinal studies have shown that Doppler abnormalities of the ductus venosus in FGR reflect an advanced stage of fetal compromise, associated with increased perinatal morbidity and mortality.

    “Longitudinal studies have shown that Doppler abnormalities of the ductus venosus in FGR reflect an advanced stage of fetal compromise, associated with increased perinatal morbidity and mortality.2,23,55,110e117”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites 2,23,55,110e117

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The middle cerebral artery is the largest vessel of the fetal cerebral circulation and carries about 80% of cerebral blood flow.

    “The middle cerebral artery is the largest vessel of the fetal cerebral circulation and carries about 80% of cerebral blood flow.122”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [122] Veille, 1993, Longitudinal quantitation of middle cerebral artery blood flow in normal human fetuses, Am J Obstet Gynecol source

  • May combine two claims.

    Interpretationcitation

    AEDV/REDV in the umbilical artery reflects significant placental deterioration and is associated with high perinatal mortality.

    “AEDV/REDV in the umbilical artery reflects the presence of significant placental deterioration and is associated with high perinatal mortality.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Doppler abnormalities of the ductus venosus in the setting of a normal umbilical artery Doppler indicate an alternative pathophysiological etiology, possibly related to fetal cardiac, vascular, or genetic abnormalities, and are most often not reflective of significant placental disease.

    “Doppler abnormalities of the ductus venosus in the setting of a normal umbilical artery Doppler indicate an alternative pathophysiological etiology, possibly related to the presence of fetal cardiac, vascular, or genetic abnormalities, and thus are most often not reflective of significant placental disease.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisenone given

    Absent or reversed A-wave of the ductus venosus represents an advanced stage of fetal compromise and is uncommon.

    “Furthermore, absent or reversed A-wave of the ductus venosus represents an advanced stage of fetal compromise and is uncommon.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    A meta-analysis of FGR at <34 weeks reported an odds ratio for stillbirth of 11.16 (95% CI, 6.31e19.73) for absent or reversed A-wave of the ductus venosus, a stillbirth frequency of 20%, and a stillbirth risk of 46% with a reversed A-wave.

    “A meta-analysis of FGR at <34 weeks of gestation reported odds ratios for stillbirth of 11.16 (95% CI, 6.31e19.73)for absent or reversed A-wave of the ductus venosus and a frequency of stillbirth of 20%; the risk of stillbirth with a reversed A-wave was 46%. 100”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [100] Caradeux, 2018, Risk of fetal death in growth-restricted fetuses with umbilical and/or ductus venosus absent or reversed end-diastolic velocities before 34 weeks of gestation: a systematic review and meta-analysis, Am J Obstet Gynecol source

  • May combine two claims.

    Premisecitation

    Growth-restricted fetuses, particularly those with AEDV/REDV, are at increased risk for decelerations in labor, emergency cesarean delivery, and metabolic acidemia at delivery.

    “Growth-restricted fetuses, particularly those with AEDV/REDV, are at an increased risk for decelerations in labor, emergency cesarean delivery, and metabolic acidemia at delivery.170,171”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [170] Lin, 1980, Acid-base characteristics of fetuses with intrauterine growth retardation during labor and delivery, Am J Obstet Gynecol source
    • cites [171] Baschat, 2000, Umbilical artery doppler screening for detection of the small fetus in need of antepartum surveillance, Am J Obstet Gynecol source
    • Rests on an assumption: The decision for delivery in FGR is driven by fetal and maternal factors.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Fetal deterioration has been reported to be independently reflected by Doppler and BPP testing.

    “fetal deterioration has been reported to be independently reflected by Doppler and BPP testing”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [155] Figueras, 2011, Intrauterine growth restriction: new concepts in antenatal surveillance, diagnosis, and management, Am J Obstet Gynecol source
35 of 35

  • The paper relies on this without support.

    CTG is currently accepted as the primary method for fetal surveillance in high-risk pregnancies in the United States.

    “CTG is currently accepted as the primary method for fetal surveillance in high-risk pregnancies in the United States.”

  • The paper relies on this without support.

    The decision for delivery in FGR is driven by fetal and maternal factors.

    “The decision for delivery in FGR is driven by fetal and maternal factors.”

  • The paper relies on this without support.

    An abnormal umbilical artery Doppler waveform reflects the presence of placental insufficiency and can help differentiate the growth-restricted fetus from the constitutionally small fetus.

    “An abnormal umbilical artery Doppler waveform reflects the presence of placental insufficiency and can help differentiate the growth-restricted fetus from the constitutionally small fetus.”

  • The paper relies on this without support.

    Fetal hypoxemia associated with growth restriction results in cerebral vasodilation, an early adaptive mechanism termed the brain-sparing effect.

    “Fetal hypoxemia associated with growth restriction results in cerebral vasodilation, an early adaptive mechanism termed the brain-sparing effect.”

  • The paper relies on this without support.

    Measurement of flow through the middle cerebral artery using Doppler can identify cerebral vasodilation, which can be quantified using PI or the cerebroplacental ratio (CPR).

    “Measurement of flow through the middle cerebral artery using Doppler can identify cerebral vasodilation, which can be quantified using PI or the cerebroplacental ratio (CPR).”

  • The paper relies on this without support.

    Uterine artery Doppler assesses the maternal component of placental blood flow and is a marker of remodeling of the spiral arteries by trophoblastic cellular invasion.

    “Uterine artery Doppler assesses the maternal component of placental blood flow and is a marker of remodeling of the spiral arteries by trophoblastic cellular invasion.”

  • The paper relies on this without support.

    This pregnancy adaptation optimizes the intervillous placental blood flow and delivery of oxygen and nutrients to the fetus.

    “This pregnancy adaptation optimizes the intervillous placental blood flow and delivery of oxygen and nutrients to the fetus.”

  • The paper relies on this without support.

    There are limited data to inform recommendations regarding the mode of delivery in pregnancies complicated by FGR.

    “There are limited data to inform recommendations regarding the mode of delivery in pregnancies complicated by FGR.”

  • The paper relies on this without support.

    More recent studies have questioned the value of BPP in fetal surveillance of high-risk pregnancies, including early-onset severe FGR, because of a high prevalence of false-positive and false-negative results.

    “More recent studies have questioned the value of BPP in fetal surveillance of high-risk pregnancies, including early-onset severe FGR, because of a high prevalence of false-positive and false-negative results.”
9 of 9

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

  • CMV percentage does not match the reported study size

    Minor

    Six cases among 319 pregnancies is 1.88%, which rounds to 1.9% rather than the reported 1.8%.

    Reported 1.8 · recomputed 1.880878

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Frauenschuh, 2014, [Ductus venosus blood flow prior to intrauterine foetal death in severe placental insufficiency can be unaffected as shown by doppler sonography], Z Geburtshilfe Neonatol, 218, 218

Cited by

Sorted by citations

Related

Authors
Martins, J. G., Biggio, J. R., & Abuhamad, A.
Affiliations
Society for Maternal-Fetal Medicine (US)
ORCID
Venue
American Journal of Obstetrics and Gynecology
Publisher
Elsevier BV
Published
2020-10
Volume
223
Issue
4
Pages
B2-B17
ISSN
0002-9378 (ISSN-L)
DOI
10.1016/j.ajog.2020.05.010
OpenAlex
W3025237121
Cited by
549
References
194
Citations by year
2026: 105 · 2025: 103 · 2024: 91 · 2023: 98 · 2022: 75 · 2021: 61 · 2020: 8
FWCI
22.33
Type
journal article
Language
en
Open access
Licence
Locations
  • American Journal of Obstetrics and Gynecology (publishedVersion)
  • PubMed (publishedVersion)
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 › Pediatrics, Perinatology and Child Health › Prenatal Screening and Diagnostics
Keywords
fetal growth restriction, prenatal diagnosis, low molecular weight heparin, sildenafil, activity limitation, chromosomal microarray analysis, prenatal diagnostic testing, umbilical artery Doppler
MeSH terms
Adrenal Cortex Hormones, Cesarean Section, Chromosome Aberrations, Female, Fetal Growth Retardation, Gestational Age, Hospitalization

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

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