Abstract

INTRODUCTION: To evaluate the relative value of mid trimester fetal growth, uterine artery (UtA) Doppler indices and maternal demographics in prediction of stillbirth. MATERIAL AND METHODS: Retrospective cohort study; 23,894 singleton pregnancies routinely scanned between 19 and 24 weeks' gestation. Maternal characteristics included age, body mass index, ethnicity and medical history. Fetal biometry indices, birthweight and UtA pulsatility index (PI) values were converted to percentiles and multivariable logistic regression analysis was performed. The predictive accuracy was assessed using ROC curves analysis. The main outcome was prediction of preterm and term stillbirths. RESULTS: Non-Caucasian ethnicity, femur length centile and UtA PI were significantly associated with the risk of stillbirth (all p <0.01). The detection rate of screening by maternal factors alone was 19% for all stillbirths, and 12% and 14% for term and preterm stillbirth at a 10% false positive rate; using femur length centile alone the detection rates were 27% and 23% respectively. UtA PI alone was able to predict 24% and 31% of term and preterm stillbirths. Screening by combining maternal factors, femur length centile and UtA Doppler detected 27% and 35% of term and preterm stillbirths at a 10% false positive rate. CONCLUSIONS: Second trimester ultrasound assessment offers an opportunity to identify pregnancies at the highest risk of stillbirth occurring as a consequence of placental dysfunction. This information may be useful to improve pregnancy outcome by identifying women who may benefit from increased ultrasound surveillance and/or timely intervention. This article is protected by copyright. All rights reserved.