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Medscape
01-07-2025
- Health
- Medscape
Ultrasound and Maternal Data Predict Prolonged NICU Stay
TOPLINE: Maternal factors, particularly social deprivation, 36-week ultrasound scan results, and labour/delivery data independently predicted the risk for prolonged NICU admission at term. METHODOLOGY: Researchers conducted a retrospective analysis of a prospective cohort study including 107,762 women with singleton pregnancies who underwent a routine 36-week ultrasound scan (35 + 0 to 36 + 6 weeks of gestation) between March 2014 and November 2023. They assessed maternal factors (maternal demographics, obstetric and medical history, and pregnancy characteristics) and findings from the scan at week 36 including estimated foetal weight (EFW) and Doppler measurements (uterine artery, umbilical artery, and middle cerebral artery). Other outcomes such as gestational age at delivery, mode of delivery, and birth weight were evaluated. The primary outcome was prolonged NICU admission (> 2 days) for high-dependency or intensive care (total parenteral nutrition or invasive ventilation). TAKEAWAY: Of 107,762 singleton pregnancies, 946 (0.88%) delivered neonates requiring NICU admission. Social deprivation (Index of Multiple Deprivation [IMD]) was an independent predictor of prolonged NICU admission (IMD quintile 1 [most deprived] vs 5 [least deprived]: adjusted odds ratio [aOR], 1.96; P < .001), surpassing ethnicity and other maternal factors. The combined model (maternal factors + 36-week scan data) showed that EFW < 10th percentile (aOR, 1.85; P < .001) and > 90th percentile (aOR, 1.58; P < .001) were significant predictors of the risk for NICU admission. The combined model (maternal factors + 36-week scan data + delivery data) detected 39.1% of prolonged NICU admissions; however, more than 40% of these admissions remained unpredictable. IN PRACTICE: "Our findings illustrate that most prolonged NICU admissions are not predictable based on routinely available variables and, even when analyses were restricted to those admissions theoretically predictable by maternal factors or 36-week scan findings, more than 40% of prolonged NICU admissions were not predictable," the authors wrote. "These data should be included in informed decision-making with regards to place of birth, given the importance of continuous monitoring and ready access to skilled maternity-care providers," they added. SOURCE: This study was led by A. Arechvo, Fetal Medicine Research Institute, King's College Hospital, London, England. It was published online on June 21, 2025, in Ultrasound in Obstetrics & Gynecology. LIMITATIONS: Although IMD was the standard measure of social deprivation in the UK, it was based on the postcode of residence and may not have accurately reflected individual-level deprivation. This study lacked data on maternal mental health problems, medications, infections, and operative vaginal delivery. DISCLOSURES: This study was supported by a grant from the Fetal Medicine Foundation. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
24-06-2025
- Health
- Medscape
Mid-Gestation Assessment of Small-for-Gestational-Age Risk
TOPLINE: Assessing the risk for small for gestational age (SGA) at mid-gestation (19 + 0 to 23 + 6 weeks) using maternal risk factors together with the estimated foetal weight and uterine artery pulsatility index (UtA-PI) could identify pregnancies requiring monitoring at 26, 30, and 33 weeks, complementing a routine 36-week ultrasound scan. METHODOLOGY: Researchers conducted a prospective, non-intervention study to predict the risk for SGA at mid-gestation by combining maternal risk factors with the estimated foetal weight and UtA-PI. They included 134,443 women with singleton pregnancies who underwent routine ultrasound scans at 19 + 0 to 23 + 6 weeks of gestation between January 2011 and May 2024. Different risk cutoffs were used to detect approximately 80%, 85%, and 90% of cases of delivery with SGA at < 28, < 32, and < 36 weeks of gestation, respectively. Outcomes of interest were the delivery of SGA neonates with birth weight less than 10th or 3rd percentile at < 28, < 32, and < 36 weeks of gestation. TAKEAWAY: Among singleton pregnancies, 12.51% delivered SGA neonates with birth weight less than 10th percentile, including 0.15% at < 28 weeks, 0.42% at < 32 weeks, and 1.33% at < 36 weeks. Similarly, 5.15% of pregnancies delivered SGA neonates with birth weight less than third percentile, including 0.11%, 0.33%, and 0.92% at < 28, < 32, and < 36 weeks, respectively. Screen positive rates for detecting 80% of SGA neonates with birth weight less than 10th percentile were 9.5% at < 28 weeks, 19.6% at < 32 weeks, and 29.6% at < 36 weeks. Similarly, screen positive rates for detecting 80% of SGA neonates with birth weight less than third percentile were 6.5%, 13.0%, and 21.6% at < 28, < 32, and < 36 weeks, respectively. IN PRACTICE: "Future research should focus on the clinical implementation of the proposed stratification plan offering timely ultrasound scans after 24 weeks, according to the second trimester integrated risk assessment. The targeted ultrasound scans between 24 to 36 weeks gestation may improve the management of SGA pregnancies," the authors wrote. SOURCE: This study was led by Ioannis Papastefanou, MD, Fetal Medicine Research Institute, King's College Hospital, London, England. It was published online on June 12, 2025, in the American Journal of Obstetrics and Gynecology. LIMITATIONS: The study results were limited to only singleton pregnancies. Risk cutoffs for assigning the population into each of the three management groups will vary according to the local resources and preferences. Spanning over 13 years, changes in antenatal care during this period may have influenced the findings; however, second trimester measurements, techniques, or distributions for foetal biometry and UtA-PI remained consistent. DISCLOSURES: This study was supported by a grant from the Fetal Medicine Foundation. The authors declared having no conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
