title: Diagnostic accuracy of placental growth factor and ultrasound parameters to predict the small-for-gestational-age infant in women presenting with reduced symphysis-fundus height.
abstract: OBJECTIVE
  To assess the diagnostic accuracy of placental growth factor (PlGF) and ultrasound parameters to predict delivery of a small-for-gestational-age (SGA) infant in women presenting with reduced symphysis-fundus height (SFH).
  
  
  METHODS
  This was a multicenter prospective observational study recruiting 601 women with a singleton pregnancy and reduced SFH between 24 and 37 weeks' gestation across 11 sites in the UK and Canada. Plasma PlGF concentration < 5(th) centile, estimated fetal weight (EFW) < 10(th) centile, umbilical artery Doppler pulsatility index > 95(th) centile and oligohydramnios (amniotic fluid index < 5 cm) were compared as predictors for a SGA infant < 3(rd) customized birth-weight centile and adverse perinatal outcome. Test performance statistics were calculated for all parameters in isolation and in combination.
  
  
  RESULTS
  Of the 601 women recruited, 592 were analyzed. For predicting delivery of SGA < 3(rd) centile (n = 78), EFW < 10(th) centile had 58% sensitivity (95% CI, 46-69%) and 93% negative predictive value (NPV) (95% CI, 90-95%), PlGF had 37% sensitivity (95% CI, 27-49%) and 90% NPV (95% CI, 87-93%); in combination, PlGF and EFW < 10(th) centile had 69% sensitivity (95% CI, 55-81%) and 93% NPV (95% CI, 89-96%). The equivalent receiver-operating characteristics (ROC) curve areas were 0.79 (95% CI, 0.74-0.84) for EFW < 10(th) centile, 0.70 (95% CI, 0.63-0.77) for low PlGF and 0.82 (95% CI, 0.77-0.86) in combination.
  
  
  CONCLUSIONS
  For women presenting with reduced SFH, ultrasound parameters had modest test performance for predicting delivery of SGA < 3(rd) centile. PlGF performed no better than EFW < 10(th) centile in determining delivery of a SGA infant.
authors.affiliation: Women's Health Academic Centre, King's College London, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Griffin
authors.affiliation: Women's Health Academic Centre, King's College London, London, UK.
authors.forename: P T
authors.initials: PT
authors.lastname: Seed
authors.affiliation: Women's Health Academic Centre, King's College London, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Webster
authors.affiliation: Maternal and Fetal Health Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
authors.forename: J
authors.initials: J
authors.lastname: Myers
authors.affiliation: Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: L
authors.initials: L
authors.lastname: MacKillop
authors.affiliation: Section of Obstetrics & Gynaecology, Institute of Biochemical & Clinical Sciences, University of Leeds, Leeds, UK.
authors.forename: N
authors.initials: N
authors.lastname: Simpson
authors.affiliation: Academic Unit of Reproductive and Developmental Medicine, University of Sheffield, Sheffield, UK.
authors.forename: D
authors.initials: D
authors.lastname: Anumba
authors.affiliation: St George's Hospital Medical School, University of London, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Khalil
authors.affiliation: St Michael's Hospital, Bristol, UK.
authors.forename: M
authors.initials: M
authors.lastname: Denbow
authors.affiliation: University Hospital, Lewisham, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Sau
authors.affiliation: Sunderland Royal Hospital, Sunderland, UK.
authors.forename: K
authors.initials: K
authors.lastname: Hinshaw
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada.
authors.forename: P
authors.initials: P
authors.lastname: von Dadelszen
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Benton
authors.affiliation: West Middlesex University Hospital, Isleworth, Middlesex, UK.
authors.forename: J
authors.initials: J
authors.lastname: Girling
authors.affiliation: Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK.
authors.forename: C W G
authors.initials: CW
authors.lastname: Redman
authors.affiliation: Women's Health Academic Centre, King's College London, London, UK.
authors.forename: L C
authors.initials: LC
authors.lastname: Chappell
authors.affiliation: Women's Health Academic Centre, King's College London, London, UK.
authors.forename: A H
authors.initials: AH
authors.lastname: Shennan
mesh_terms: D000328:Adult; D000653:Amniotic Fluid / Q000000981:diagnostic imaging; D005260:Female; D005317:Fetal Growth Retardation / Q000097:blood* / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age / Q000097:blood*; D036341:Intercellular Signaling Peptides and Proteins; D000072483:Placenta Growth Factor; D011237:Predictive Value of Tests; D011247:Pregnancy; D011257:Pregnancy Proteins / Q000097:blood*; D011263:Pregnancy Trimester, Third; D011631:Pubic Symphysis / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D012372:ROC Curve; D015203:Reproducibility of Results; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging; D014599:Uterus / Q000000981:diagnostic imaging
chemical_list: D036341:Intercellular Signaling Peptides and Proteins; C000608036:PGF protein, human; D011257:Pregnancy Proteins; D000072483:Placenta Growth Factor
keywords: estimated fetal weight; fetal growth restriction; placental growth factor; small-for-gestational age
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