title: The use of ultrasound to detect small-for-gestational-age infants in patients with elevated human chorionic gonadotropin on maternal serum screening.
abstract: We evaluated serial sonography for the antenatal detection of small-for-gestational-age (SGA) infants in pregnancies with elevated human chorionic gonadotropin (hCG) levels on midtrimester triple-marker screen. A retrospective cohort study was performed at Saddleback Memorial Medical Center where serial ultrasounds from 26 weeks to delivery are generally recommended for patients with hCG levels >2.0 Multiple of the Median (MoM). From 1999 to 2007, 659 subjects were identified for analysis. The incidence of intrauterine growth restriction (IUGR) and SGA were 5.2% and 7.3%, respectively. Antenatal ultrasound identified 31.3% of SGA infants. Compared with estimated fetal weight (EFW) <10th percentile alone, abdominal circumference (AC) <10th percentile improved the detection of SGA from 31.3% (95% confidence interval [CI], 18.7 to 46.3) to 35.4% (95% CI, 22.2 to 50.5). Using either EFW or AC further increased the sensitivity to 45.8% (95% CI, 31.4 to 60.8). The sensitivity for the detection of SGA was 100% when an EFW cutoff of 75% was used. Ultrasound can be used to detect SGA infants in patients with elevated hCG levels on midtrimester serum screening. A sonographic estimated fetal weight > or = 75th percentile appears to be a safe cutoff to rule out all fetuses at risk for SGA.
authors.affiliation: Department of Obstetrics and Gynecology, University of California, Irvine, Orange, CA, USA. mfm@uci.edu
authors.forename: Tamera
authors.initials: T
authors.lastname: Hatfield
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
authors.forename: David C
authors.initials: DC
authors.lastname: Lagrew
authors.forename: Ryan
authors.initials: R
authors.lastname: Heintz
authors.forename: Judith H
authors.initials: JH
authors.lastname: Chung
mesh_terms: D000328:Adult; D006063:Chorionic Gonadotropin / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis*; D020567:Fetal Weight; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D016104:Oligohydramnios / Q000453:epidemiology; D011225:Pre-Eclampsia / Q000453:epidemiology; D011237:Predictive Value of Tests; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal; D055105:Waist Circumference
chemical_list: D006063:Chorionic Gonadotropin