Evaluating the accuracy and precision of sonographic fetal weight estimation models in extremely early-onset fetal growth restrictionCitation formats

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Evaluating the accuracy and precision of sonographic fetal weight estimation models in extremely early-onset fetal growth restriction. / Warrander, Lynne; Ingram, Emma; Heazell, Alexander; Johnstone, Edward.

In: Acta Obstetricia et Gynecologica Scandinavica, Vol. 99, No. 3, 20.03.2020, p. 363-374.

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@article{4a34f40c7d534da1a0cb9ef4ea12aef0,
title = "Evaluating the accuracy and precision of sonographic fetal weight estimation models in extremely early-onset fetal growth restriction",
abstract = "IntroductionBirthweight is a critical predictor of survival in extremely early-onset fetal growth restriction (fetal growth restriction diagnosed pre-28 weeks{\textquoteright} gestation, with abnormal umbilical/uterine artery Doppler waveforms), therefore accurate fetal weight estimation is a crucial component of antenatal management. Currently available sonographic fetal weight estimation models were predominantly developed in populations of mixed gestational age and varying fetal weights, but not specifically tested within the context of extremely early-onset fetal growth restriction. This study aimed to determine the accuracy and precision of fetal weight estimation in this population and investigate if model performance is affected by other factors.Materials & MethodsCases where a growth scan was performed within 48 hours of delivery (n=65) were identified from a cohort of extremely early-onset fetal growth restricted pregnancies at a single tertiary maternity centre (n=159). Fetal biometry measurements were used to calculate estimated fetal weight using 21 previously published models. Systematic and random errors were calculated for each model and used to identify the best performing model, which in turn was used to explore the relationship between error and gestation, estimated fetal weight, fetal presentation, fetal asymmetry and amniotic fluid volume.ResultsBoth systematic (median 8.2%; range -44.1% – 49.5%) and random error (median 11.6%; range 9.7% – 23.8%) varied widely across models. The best performing model was Hadlock HC-AC-FL, regardless of gestational age, fetal size, fetal presentation or asymmetry, with an overall systematic error of 1.5% and random error of 9.7%. Despite this, it only calculated the estimated fetal weight within 10% of birthweight in 64.6% of cases. There was a weak negative relationship between mean percentage error with Hadlock HC-AC-FL and amniotic fluid volume, suggesting fetal weight is overestimated at lower liquor volumes and underestimated at higher liquor volumes (P=0.002, adjusted R2=0.08).ConclusionsHadlock HC-AC-FL is the most accurate model currently available to estimate fetal weight in extremely early-onset fetal growth restriction independent of gestation or fetal size, asymmetry or presentation. However, for 35.4% of cases in this study, estimated fetal weight calculated using this model deviates by more than 10% from birthweight, highlighting a need for an improved model.",
keywords = "antenatal assessment, antenatal ultrasound, fetal growth, fetal growth restriction, prematurity, sonographic fetal weight models, survival prediction",
author = "Lynne Warrander and Emma Ingram and Alexander Heazell and Edward Johnstone",
year = "2020",
month = mar,
day = "20",
doi = "10.1111/aogs.13745",
language = "English",
volume = "99",
pages = "363--374",
journal = "Acta Obstetricia et Gynecologica Scandinavica",
issn = "0001-6349",
publisher = "John Wiley & Sons Ltd",
number = "3",

}

RIS

TY - JOUR

T1 - Evaluating the accuracy and precision of sonographic fetal weight estimation models in extremely early-onset fetal growth restriction

AU - Warrander, Lynne

AU - Ingram, Emma

AU - Heazell, Alexander

AU - Johnstone, Edward

PY - 2020/3/20

Y1 - 2020/3/20

N2 - IntroductionBirthweight is a critical predictor of survival in extremely early-onset fetal growth restriction (fetal growth restriction diagnosed pre-28 weeks’ gestation, with abnormal umbilical/uterine artery Doppler waveforms), therefore accurate fetal weight estimation is a crucial component of antenatal management. Currently available sonographic fetal weight estimation models were predominantly developed in populations of mixed gestational age and varying fetal weights, but not specifically tested within the context of extremely early-onset fetal growth restriction. This study aimed to determine the accuracy and precision of fetal weight estimation in this population and investigate if model performance is affected by other factors.Materials & MethodsCases where a growth scan was performed within 48 hours of delivery (n=65) were identified from a cohort of extremely early-onset fetal growth restricted pregnancies at a single tertiary maternity centre (n=159). Fetal biometry measurements were used to calculate estimated fetal weight using 21 previously published models. Systematic and random errors were calculated for each model and used to identify the best performing model, which in turn was used to explore the relationship between error and gestation, estimated fetal weight, fetal presentation, fetal asymmetry and amniotic fluid volume.ResultsBoth systematic (median 8.2%; range -44.1% – 49.5%) and random error (median 11.6%; range 9.7% – 23.8%) varied widely across models. The best performing model was Hadlock HC-AC-FL, regardless of gestational age, fetal size, fetal presentation or asymmetry, with an overall systematic error of 1.5% and random error of 9.7%. Despite this, it only calculated the estimated fetal weight within 10% of birthweight in 64.6% of cases. There was a weak negative relationship between mean percentage error with Hadlock HC-AC-FL and amniotic fluid volume, suggesting fetal weight is overestimated at lower liquor volumes and underestimated at higher liquor volumes (P=0.002, adjusted R2=0.08).ConclusionsHadlock HC-AC-FL is the most accurate model currently available to estimate fetal weight in extremely early-onset fetal growth restriction independent of gestation or fetal size, asymmetry or presentation. However, for 35.4% of cases in this study, estimated fetal weight calculated using this model deviates by more than 10% from birthweight, highlighting a need for an improved model.

AB - IntroductionBirthweight is a critical predictor of survival in extremely early-onset fetal growth restriction (fetal growth restriction diagnosed pre-28 weeks’ gestation, with abnormal umbilical/uterine artery Doppler waveforms), therefore accurate fetal weight estimation is a crucial component of antenatal management. Currently available sonographic fetal weight estimation models were predominantly developed in populations of mixed gestational age and varying fetal weights, but not specifically tested within the context of extremely early-onset fetal growth restriction. This study aimed to determine the accuracy and precision of fetal weight estimation in this population and investigate if model performance is affected by other factors.Materials & MethodsCases where a growth scan was performed within 48 hours of delivery (n=65) were identified from a cohort of extremely early-onset fetal growth restricted pregnancies at a single tertiary maternity centre (n=159). Fetal biometry measurements were used to calculate estimated fetal weight using 21 previously published models. Systematic and random errors were calculated for each model and used to identify the best performing model, which in turn was used to explore the relationship between error and gestation, estimated fetal weight, fetal presentation, fetal asymmetry and amniotic fluid volume.ResultsBoth systematic (median 8.2%; range -44.1% – 49.5%) and random error (median 11.6%; range 9.7% – 23.8%) varied widely across models. The best performing model was Hadlock HC-AC-FL, regardless of gestational age, fetal size, fetal presentation or asymmetry, with an overall systematic error of 1.5% and random error of 9.7%. Despite this, it only calculated the estimated fetal weight within 10% of birthweight in 64.6% of cases. There was a weak negative relationship between mean percentage error with Hadlock HC-AC-FL and amniotic fluid volume, suggesting fetal weight is overestimated at lower liquor volumes and underestimated at higher liquor volumes (P=0.002, adjusted R2=0.08).ConclusionsHadlock HC-AC-FL is the most accurate model currently available to estimate fetal weight in extremely early-onset fetal growth restriction independent of gestation or fetal size, asymmetry or presentation. However, for 35.4% of cases in this study, estimated fetal weight calculated using this model deviates by more than 10% from birthweight, highlighting a need for an improved model.

KW - antenatal assessment

KW - antenatal ultrasound

KW - fetal growth

KW - fetal growth restriction

KW - prematurity

KW - sonographic fetal weight models

KW - survival prediction

UR - https://doi.org/10.1111/aogs.13745

U2 - 10.1111/aogs.13745

DO - 10.1111/aogs.13745

M3 - Article

VL - 99

SP - 363

EP - 374

JO - Acta Obstetricia et Gynecologica Scandinavica

JF - Acta Obstetricia et Gynecologica Scandinavica

SN - 0001-6349

IS - 3

ER -