title: Second-trimester prediction of delivery of a small-for-gestational-age neonate: integrating sequential Doppler information, fetal biometry, and maternal characteristics.
abstract: OBJECTIVE
  The aim of this study was to investigate the predictive accuracy of second-trimester ultrasound parameters, maternal characteristics, and sequential Doppler changes between first and second trimesters for the prediction of small-for-gestational-age (SGA) infants (birth weight < 10th percentile).
  
  
  METHODS
  We conducted a prospective study of singleton pregnancies enrolled in the first trimester with subsequent second-trimester follow-up. Maternal characteristics, uterine artery (UtA) pulsatility index (PI), fetal biometry, and umbilical artery (UA)-PI were ascertained. UtA and UA-PI change from first to second trimester was calculated (ΔUtA-PI and ΔUA-PI). These parameters were tested for their ability to predict delivery of an SGA infant.
  
  
  RESULTS
  Among 1982 women, 172 delivered an SGA neonate. African-American ethnicity, nulliparity, tobacco use, and low abdominal circumference (AC) z-score were independent predictors of SGA. No difference was found in the magnitude of ΔUtA-PI and ΔUA-PI between SGA and no-SGA. Receiver-operating characteristics curve analysis yielded an area under the curve of 0.700 for AC z-score. The combination of low AC and bilateral notching had high specificity (99%) but low sensitivity (7%) for SGA prediction.
  
  
  CONCLUSIONS
  A small second-trimester fetal AC is a specific marker for SGA when found with bilateral UtA notching. Only a small proportion is predicted by the factors studied, suggesting a small contributory role or later evolution of SGA.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Viola
authors.initials: V
authors.lastname: Seravalli
authors.forename: Dana M
authors.initials: DM
authors.lastname: Block-Abraham
authors.forename: Ozhan M
authors.initials: OM
authors.lastname: Turan
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Doyle
authors.forename: Miriam G
authors.initials: MG
authors.lastname: Blitzer
authors.forename: Ahmet A
authors.initials: AA
authors.lastname: Baschat
mesh_terms: D000328:Adult; D001724:Birth Weight; D001837:Body Weights and Measures; D036861:Delivery, Obstetric; D005260:Female; D047109:Fetal Development; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging*; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D008423:Maternal Age; D009035:Mothers; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D012959:Socioeconomic Factors; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D055815:Young Adult