title: Performance of third-trimester combined screening model for prediction of adverse perinatal outcome.
abstract: OBJECTIVE
  To explore the potential value of third-trimester combined screening for the prediction of adverse perinatal outcome (APO) in the general population and among small-for-gestational-age (SGA) fetuses.
  
  
  METHODS
  This was a nested case-control study within a prospective cohort of 1590 singleton gestations undergoing third-trimester evaluation (32 + 0 to 36 + 6 weeks' gestation). Maternal baseline characteristics, mean arterial blood pressure, fetoplacental ultrasound and circulating biochemical markers (placental growth factor (PlGF), lipocalin-2, unconjugated estriol and inhibin A) were assessed in all women who subsequently had an APO (n = 148) and in a control group without perinatal complications (n = 902). APO was defined as the occurrence of stillbirth, umbilical artery cord blood pH < 7.15, 5-min Apgar score < 7 or emergency operative delivery for fetal distress. Logistic regression models were developed for the prediction of APO in the general population and among SGA cases (defined as customized birth weight < 10thcentile).
  
  
  RESULTS
  The prevalence of APO was 9.3% in the general population and 27.4% among SGA cases. In the general population, a combined screening model including a-priori risk (maternal characteristics), estimated fetal weight (EFW) centile, umbilical artery pulsatility index (UA-PI), estriol and PlGF achieved a detection rate for APO of 26% (area under receiver-operating characteristics curve (AUC), 0.59 (95% CI, 0.54-0.65)), at a 10% false-positive rate (FPR). Among SGA cases, a model including a-priori risk, EFW centile, UA-PI, cerebroplacental ratio, estriol and PlGF predicted 62% of APO (AUC, 0.86 (95% CI, 0.80-0.92)) at a FPR of 10%.
  
  
  CONCLUSIONS
  The use of fetal ultrasound and maternal biochemical markers at 32-36 weeks provides a poor prediction of APO in the general population. Although it remains limited, the performance of the screening model is improved when applied to fetuses with suboptimal fetal growth. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
authors.affiliation: BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, IDIBAPS, University of Barcelona, Barcelona, Spain.|Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors.forename: J
authors.identifier: http://orcid.org/0000-0003-0372-8374
authors.initials: J
authors.lastname: Miranda
authors.affiliation: BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, IDIBAPS, University of Barcelona, Barcelona, Spain.|Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Triunfo
authors.affiliation: BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, IDIBAPS, University of Barcelona, Barcelona, Spain.|Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Rodriguez-Lopez
authors.affiliation: PerkinElmer, Inc., Turku, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Sairanen
authors.affiliation: PerkinElmer, Inc., Turku, Finland.
authors.forename: H
authors.initials: H
authors.lastname: Kouru
authors.affiliation: BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, IDIBAPS, University of Barcelona, Barcelona, Spain.|Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.|Maternal-Fetal Unit, CEDIFETAL, Centro de Diagnostico de Ultrasonido e Imágenes, CEDIUL, Barranquilla, Colombia.
authors.forename: M
authors.initials: M
authors.lastname: Parra-Saavedra
authors.affiliation: BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, IDIBAPS, University of Barcelona, Barcelona, Spain.|Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Crovetto
authors.affiliation: BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, IDIBAPS, University of Barcelona, Barcelona, Spain.|Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Figueras
authors.affiliation: BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, IDIBAPS, University of Barcelona, Barcelona, Spain.|Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors.forename: F
authors.identifier: http://orcid.org/0000-0002-7422-5240
authors.initials: F
authors.lastname: Crispi
authors.affiliation: BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, IDIBAPS, University of Barcelona, Barcelona, Spain.|Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors.forename: E
authors.identifier: http://orcid.org/0000-0002-7405-7224
authors.initials: E
authors.lastname: Gratacós
mesh_terms: D000328:Adult; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood*; D016022:Case-Control Studies; D005260:Female; D005333:Fetus / Q000098:blood supply; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D007265:Inhibins / Q000097:blood; D000071068:Lipocalin-2 / Q000097:blood; D008962:Models, Theoretical; D000072483:Placenta Growth Factor / Q000097:blood; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third; D011673:Pulsatile Flow; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology
chemical_list: D015415:Biomarkers; D000071068:Lipocalin-2; C000608036:PGF protein, human; C422362:inhibin A; D000072483:Placenta Growth Factor; D007265:Inhibins
keywords: Doppler; biochemical markers; fetal growth restriction; perinatal outcome; small-for-gestational age; third-trimester screening