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Q&A

Intrapartum Fetal Assessment

Poster Session 1

(342) Fetal Outcomes in Growth Restriction with Expansion of Abdominal Circumference Diagnostic Criteria

Tuesday, February 13, 2024
10:30 AM – 12:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee
Objective:

This retrospective cohort study assessed the effect of changing fetal growth restriction (FGR) diagnostic criteria to include abdominal circumference (AC) less than the 10th %ile on the occurrence of adverse neonatal outcomes (ANO) in a single institution. We hypothesized that this protocol change would not affect ANO rates.

Study Design:

We utilized the Intergenerational Health Knowledgebase (IHK) which extracts clinical data from electronic health record with high fidelity (IRB# 201902830). Demographic and pregnancy outcome data were extracted for birth parents and babies.  AC< 10th percentile was added as diagnostic criteria for FGR on 6/22/20.  Pregnancy episodes with a known diagnosis of FGR were categorized as pre-protocol (delivered prior to 6/22/20) and post-protocol (delivered after 1/1/21).  Pre-protocol criteria included EFW< 10%ile and/or AC< 5%ile. Post-protocol criteria included EFW< 10%ile and/or AC< 10th %ile. A combined ANO variable included admission to NICU, PTX, RDS, IVH, PVL, NEC, Pulm HTN, sepsis, and HIE. T tests, chi square, and logistic regression analyses were performed with a=0.05.

Results:

1548 pre-protocol and 242 post-protocol unique FGR pregnancies were identified.  Maternal age, race, rate of hypertensive disease in pregnancy (HDP) and diabetes were similar between cohorts. Birthweights, 1 and 5 min. APGARs, gestational age of delivery (37.1 vs. 36.6, p=0.9), and ANO rate (49% vs. 43%, p=0.1) were also similar between groups.  When controlling for HDP, DM, and maternal age, change in FGR diagnostic protocol (OR 0.795, P = 0.13) was not associated with increased development of ANO in FGR fetuses. The model did identify a statistically significant increase in ANO among FGR neonates where HDP was also present in the pregnancy episode (OR 2.12, P < 0.001).

Conclusion:

Expansion of FGR diagnostic criteria to include AC< 10th %ile demonstrated no difference in fetal outcomes despite increased surveillance and ultrasound burden. Further work to evaluate the cost effectiveness of this strategy will further elucidate the potential effects of this FGR diagnostic criteria change.