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Fetus

Poster Session 4

(955) Second Trimester Fetal Growth Restriction with Estimated Fetal Weight 3rd Percentile or Less

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Among individuals with fetal growth restriction (FGR) diagnosed in the mid second trimester (18-24 weeks), we assessed risk factors and associated outcomes with estimated fetal weight (EFW) 3rd percentile or less versus 4 - 9th percentile at diagnosis.

Study Design: This was a single center retrospective study (2018 - 2021) of singletons with FGR (estimated weight [EFW] and/or abdominal circumference [AC] < 10th percentile for gestational age, Hadlock) identified at 18 – 24 weeks' with reliable estimated delivery date. We compared maternal and pregnancy characteristics as well as outcomes in pregnancies that were EFW ≤ 3rd percentile at initial diagnosis versus 4 - 9th percentile. We excluded anomalous gestations and those without delivery outcomes. Primary outcome was small for gestational age (SGA, birthweight < 10th percentile, Fenton) with secondary outcomes including other neonatal and maternal outcomes.

Results:

During the study period, 28,703 ultrasounds were performed between 18 – 24 weeks' gestation, with 398 (1.4%) singleton gestations diagnosed with FGR. 160 patients (40.2%) met all inclusion criteria. Of these, 93 (58.1%) were EFW 4 - 9th percentile and 67 (41.9%) were EFW ≤ 3rd percentile. Maternal characteristics were similar between groups. Those with EFW ≤ 3rd percentile were more likely to meet criteria for FGR by AC and EFW than those with EFW 4 - 9th percentile (Table). The primary outcome of SGA was more likely in those with EFW ≤ 3rd percentile (38.7% EFW 4-9th % vs. 61.5% EFW ≤ 3rd %,Table). All intrauterine fetal demises occurred in those with EFW ≤ 3rd percentile. Maternal hypertensive disorders of pregnancy were similar between groups (Table).


Conclusion: Six in 10 fetuses with EFW ≤ 3rd percentile at midtrimester ultrasound will be SGA and are at higher risk of intrauterine fetal demise than those meeting criteria for FGR with EFW 4 - 9th percentile.