title: Prediction of stillbirth from maternal factors, fetal biometry and uterine artery Doppler at 19-24 weeks.
abstract: OBJECTIVE
  To evaluate the performance of screening for all stillbirths and those due to impaired placentation and unexplained or other causes using a combination of maternal factors, fetal biometry and uterine artery pulsatility index (UtA-PI) at 19-24 weeks' gestation and to compare this performance with that of screening by UtA-PI alone.
  
  
  METHODS
  This was a prospective screening study of 70 003 singleton pregnancies including 69 735 live births and 268 (0.38%) antepartum stillbirths; 159 (59%) were secondary to impaired placentation and 109 (41%) were due to other or unexplained causes. Multivariable logistic regression analysis was used to develop a model for prediction of stillbirth based on a combination of maternal factors, fetal biometry and UtA-PI.
  
  
  RESULTS
  Combined screening predicted 55% of all stillbirths, including 75% of those due to impaired placentation and 23% of those that were unexplained or due to other causes, at a false-positive rate of 10%. Within the impaired placentation group, the detection rate of stillbirth < 32 weeks' gestation was higher than that of stillbirth ≥ 37 weeks (88% vs 46%; P < 0.001). The performance of screening by the combined test was superior to that of selecting the high-risk group on the basis of UtA-PI > 90thpercentile for gestational age, which predicted 48% of all stillbirths, 70% of those due to impaired placentation and 15% of those that were unexplained or due to other causes.
  
  
  CONCLUSIONS
  Second-trimester screening by a combination of UtA-PI with maternal factors and fetal biometry can predict a high proportion of stillbirths and, in particular, those that are due to impaired placentation. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
authors.affiliation: Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.|Department of Fetal Medicine, Medway Maritime Hospital, Gillingham, UK.
authors.forename: R
authors.initials: R
authors.lastname: Akolekar
authors.affiliation: Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Tokunaka
authors.affiliation: Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Ortega
authors.affiliation: Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Syngelaki
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: D000328:Adult; D001699:Biometry; D042241:Early Diagnosis; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D010920:Placenta / Q000473:pathology*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies; D050497:Stillbirth / Q000453:epidemiology*; D018608:Ultrasonography, Doppler / Q000379:methods*; D016216:Ultrasonography, Prenatal / Q000379:methods; D055988:Uterine Artery / Q000000981:diagnostic imaging*
keywords: fetal biometry; impaired placentation; pyramid of pregnancy care; stillbirth; uterine artery Doppler