title: Prediction of small-for-gestational-age neonates: screening by uterine artery Doppler and mean arterial pressure at 35-37 weeks.
abstract: OBJECTIVE
  To investigate the potential value of uterine artery (UtA) pulsatility index (PI) and mean arterial pressure (MAP) at 35-37 weeks' gestation in the prediction of delivery of small-for-gestational-age (SGA) neonates, in the absence of pre-eclampsia (PE).
  
  
  METHODS
  This was a screening study in singleton pregnancies at 35-37 weeks, including 245 that delivered SGA neonates with birth weight < 5(th) percentile and 4876 cases unaffected by SGA, PE or gestational hypertension. Multivariable logistic regression analysis was used to determine if UtA-PI and MAP improved the prediction of SGA neonates provided by screening with maternal characteristics and medical history (maternal factors), and estimated fetal weight (EFW) from fetal head circumference, abdominal circumference and femur length.
  
  
  RESULTS
  Compared to the normal group, the median multiple of the median (MoM) values of UtA-PI and MAP were significantly higher in the SGA < 5(th) group. Combined screening by maternal factors, EFW Z-score, UtA-PI and MAP at 35-37 weeks predicted, at a 10% false-positive rate, 90%, 86% and 90% of SGA neonates with birth weight < 10(th) , < 5(th) and < 3(rd) percentiles, respectively, delivering < 2 weeks following assessment; the respective values for SGA delivering ≥ 37 weeks were 66%, 74% and 80%. Such performance was not significantly different from screening by maternal factors and EFW Z-score alone.
  
  
  CONCLUSIONS
  Addition of UtA-PI and MAP to combined testing by maternal factors and fetal biometry at 35-37 weeks does not improve the performance of screening for delivery of SGA neonates.
authors.affiliation: Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Fadigas
authors.affiliation: Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Guerra
authors.affiliation: Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Garcia-Tizon Larroca
authors.affiliation: Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
authors.forename: L C
authors.initials: LC
authors.lastname: Poon
authors.affiliation: Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
authors.forename: K H
authors.initials: KH
authors.lastname: Nicolaides
mesh_terms: D062186:Arterial Pressure; D005260:Female; D020567:Fetal Weight; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D016015:Logistic Models; D000068097:Maternal Health / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011247:Pregnancy; D011263:Pregnancy Trimester, Third / Q000502:physiology*; D011446:Prospective Studies; D011673:Pulsatile Flow; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal / Q000379:methods; D055988:Uterine Artery / Q000000981:diagnostic imaging*
keywords: mean arterial pressure; pre-eclampsia; pyramid of antenatal care; small-for-gestational age; third-trimester screening; uterine artery Doppler