Detection of growth-restricted fetuses in preeclampsia: A case-control study

Objective: To determine the diagnostic accuracy of detecting growth-restric ted fetuses in women with and without preeclampsia. Methods: Over 2 years, parturients with reliable gestational ages, preeclam psia, and sonographic estimates of birth weights were matched (1:1) for ges tational age with women without preeclampsia. Paired and unpaired t tests w ere used; P < .05 was significant. Odds ratios (ORs) and 95% confidence int ervals (CIs) were calculated. Results: Two hundred eighty-seven preeclamptic women were identified and ma tched. In each group, mean (+/- standard deviation [SD]) gestational age wa s 34.9 +/- 4.2 weeks, and 166 (57.8%) infants were born preterm. Fetal grow th restriction (FGR) was significantly more common among women with preecla mpsia (14.9%) than among controls (5.6%; OR 2.98, 95% CI 1.64, 5.44). The p ercentage of sonographic estimates within 10% of actual birth weight (57.5% versus 53.6%) was similar in the two groups (OR 1.16; 95% CI 0.84,1.62). C ompared with normal growth, the mean (+/- SD) standardized absolute error w as significantly higher among those with FGR regardless of group (preeclamp sia 109 +/- 100 versus 158 +/- 152 g/kg; P = .009; control 117 +/- 103 vers us 233 +/- 206 g/kg; P < .001). Fetal growth restriction was detected more commonly among preeclamptic women than among controls (11.6% versus 0%; OR 4.74 95% CI 0.25, 90.31). The sensitivity and positive predictive value of FGR detection were 10% and 50%, respectively, among women with preeclampsia and 0% each among controls. Conclusion: Although FGR was detected more frequently in fetuses of women w ith preeclampsia than in those of controls, the ability to predict it with sonography remained poor. (C) 1999 by The American College of Obstetricians and Gynecologists.