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Q&A

Antepartum Fetal Assessment

Poster Session 1

(304) Examining the impact of antenatal small for gestational age prediction on pregnancy outcomes

Tuesday, February 13, 2024

10:30 AM – 12:00 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary Author(s)

Erika Ilatov, MD

Soroka Hospital, HaDarom, Israel

Presenting Author(s)

Alla Saban, MD, MPH

Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Beer Sheva, HaDarom, Israel, Israel

Coauthor(s)

RR

Rachel Rappaport, MD

Soroka Hospital
Beer Sheva, HaDarom, Israel
Efrat Spiegel, MD (she/her/hers)

Maternal-Fetal-Medicine Unit
Soroka University Medical Center
Omer, HaDarom, Israel
RH

Reli Hershkovitz, MD

Head of the Obstretics and Gynecology Division
Soroka Medical Center
Omer, HaDarom, Israel
AW

Adi Y. Weintraub, MD

Soroka Medical Center
Beer-Sheva, HaDarom, Israel
Tamar Eshkoli, MD

Senior
Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Beer Sheva, HaDarom, Israel, Israel

Objective: Fetal growth restriction (FGR) affects 5%-10% of pregnancies and raises the risk of maternal and neonatal mortality and morbidity. Given the difficulty of accurate fetal weight assessment in FGR, we aim to assess its impact on these outcomes.

Study Design: A retrospective study performed on June 2020 to January 2022 at a large tertiary hospital, focusing on term singleton deliveries with small gestational age (SGA) birthweights. We compared delivery traits and outcomes between women with sonographically estimated fetal growth restriction (FGR) and those mistakenly assessed as appropriate-for-gestational-age (AGA). Definitions for SGA and FGR were birthweight under 2500 gr and estimated fetal weight in the < 10th percentile,respectively, using the Israeli population's standard growth curve referred to as a Dolberg curve. Logistic regression models were used for confounder adjustment.

Results: During the study, 1,173 SGA birthweight deliveries were recorded, with 674 and 499 suspected as being appropriate and restricted growth, respectively. Patients with suspected FGR showed higher frequencies of cesarean deliveries, labor induction, maternal stays over 4 days, and more adverse maternal outcomes. Similarly, neonatal outcomes were worse in suspected FGR cases, with longer stays, higher perinatal mortality, and hypoglycemia. After multivariate analysis, only extended neonatal stay remained significant. Predicting SGA resulted in increased neonatal stays over 4 days, with an adjusted OR=1.41 (CI=1.07-1.87, p-value=0.016).

Conclusion: Prediction of SGA before birth was found as associated with neonatal length of stay exceeding 4 days. This unfortunate outcome seems to correlate with an increased frequency of interventions. The complexities surrounding this issue necessitate further research to enhance our understanding and improve clinical approaches.