Third-trimester prediction of small-for-gestational-age infants in pregnant women with sickle cell disease. Development of the ultradop index.
Twenty-seven women with homozygous sickle cell disease were followed from the third trimester until delivery. All the subjects underwent both Doppler and sonographic assessment at two points in pregnancy, periods I (28-30 weeks) and II (34-36 weeks). Estimated fetal weight (EFW) was calculated. Using a continuous wave Doppler instrument, mean systolic:end diastolic (S:D) ratios were calculated to characterize the umbilical waveforms. S:D ratios greater than or equal to 3 were designated abnormal. An index, the ultra-dop, was developed that combined ultrasound EFW less than or equal to 25th percentile and S:D greater than or equal to 3. Nine of 27 infants (33%) were small for their gestational age, with a mean gestational age of 38 +/- 2 weeks. The sensitivity, specificity and predictive values were calculated for smallness for gestational age utilizing ultrasound, Doppler velocimetry and the ultradop index for periods I and II. For period I, the highest sensitivity was obtained with the ultradop index--88.9% as compared to 77.8% with Doppler scanning and 11.1% with ultrasound. The ultradop also provided the highest positive predictive value, 88.9%; it was followed by Doppler at 77.8% and ultrasound at 50.0%. In period II the ultradop index and Doppler had the same sensitivity, 88.9%, which was much higher than for ultrasound (55.6%). As for period I, the ultradop had the highest positive predictive value, 88.9%. Our data suggest that the ultradop index provides a key assessment of women with sickle cell disease at 28-30 weeks' gestation with reference to the likelihood of their giving birth to small-for-gestational-age infants.
Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, New York.
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Anyaegbunam
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Langer
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Brustman
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J
Whitty
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Merkatz
D000328:Adult; D000755:Anemia, Sickle Cell / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001783:Blood Flow Velocity; D005069:Evaluation Studies as Topic; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011263:Pregnancy Trimester, Third; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal / Q000379:methods / Q000592:standards*; D014469:Umbilical Arteries / Q000000981:diagnostic imaging