PREDICTION OF PERINATAL MORBIDITY AT TERM IN SMALL FETUSES - COMPARISON OF FETAL GROWTH AND DOPPLER ULTRASOUND

Objective To compare fetal growth assessed by ultrasound (change in st andard deviation score of abdominal circumference and estimated fetal weight) during the third trimester with predelivery ultrasound measure ments of fetal size and Doppler measurements from the umbilical and fe tal arteries in order to predict suboptimal perinatal outcome in small babies at term. Design Prospective observational study. Setting Day a ssessment unit in a university hospital. Subjects One hundred and four consecutive women with a clinical suspicion of a small fetus during t he third trimester confirmed by ultrasound (abdominal circumference be low the 10th centile) and ultimately delivered at term. Main outcome m easures Acidaemia at birth, fetal distress requiring emergency caesare an section in labour, admission to the neonatal intensive care unit. R esults Ninety-four babies (90%) weighed less than the 10th centile and the incidence of suboptimal perinatal outcome was 27%. The largest ar eas under the receiver operating characteristic curves for suboptimal perinatal outcome were obtained with the change in standard deviation score of abdominal circumference and estimated fetal weight, and the r atios of aortic/middle cerebral and renal/middle cerebral pulsatility index. Although low, the odds ratios of the change in estimated fetal weight standard deviation score and the Doppler ratios were significan tly different from zero. Concluslion Ultrasound assessment of fetal gr owth and predelivery fetal Doppler pulsatility index ratios were super ior to predelivery estimates of fetal size and umbilical artery pulsat ility index in predicting suboptimal perinatal outcome in small fetuse s delivering at term, although the clinical value of such a prediction may be limited.