What antepartum fetal test should guide the timing of delivery of the preterm growth-restricted fetus? A decision-analysis.
OBJECTIVE
The purpose of this study was to use a decision-analytic approach to explore the best strategy for the timing of the delivery of preterm intrauterine growth-restricted fetuses.


METHODS
We constructed a decision-analysis model that compared 4 antenatal fetal testing strategies The fetal/neonatal states that were compared included live in utero pregnancy; fetal death; neonatal death; disabled neonate, and healthy neonate. Probability estimates for these states and sensitivity and specificity for Doppler velocimetry and biophysical profile were derived from literature review. Sensitivity analyses were performed on the baseline assumptions.


RESULTS
Under the baseline assumptions, biophysical profile was the best test to guide decisions on delivery. Sensitivity analyses revealed the model to be sensitive only to the specificity of a biophysical profile <82%.


CONCLUSIONS
Compared with the other options, biophysical profile was the best strategy to guide physicians on the timing of the delivery of the preterm growth-restricted fetus.
Odibo
Anthony O
AO
Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, University of Pennsylvania Medical Center, 3400 Spruce Street, 2000 Ravdin Courtyard, Philadelphia, PA 19104, USA. aodibo@mail.obgyn.upenn.edu
Quinones
Joanne N
JN
Lawrence-Cleary
Kirsten
K
Stamilio
David M
DM
Macones
George A
GA
D055592:Biophysical Phenomena; D001703:Biophysics; D003661:Decision Support Techniques; D036861:Delivery, Obstetric; D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D017078:Laser-Doppler Flowmetry; D011247:Pregnancy; D011336:Probability; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013997:Time Factors; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal