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Preventing term stillbirth

benefits and limitations of using fetal growth reference charts

Halimeh, Rawada,b,c; Melchiorre, Karena,b,c; Thilaganathan, Baskya,b,c

Current Opinion in Obstetrics and Gynecology: December 2019 - Volume 31 - Issue 6 - p 365–374
doi: 10.1097/GCO.0000000000000576
WOMEN'S HEALTH: Edited by Joseph Aquilina
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Purpose of review This review examines the variation in clinical practice with regards to ultrasound estimation of fetal weight, as well as calculation of fetal weight centiles.

Recent findings Placental dysfunction is associated with fetal smallness from intrauterine malnutrition as well as fetal disability and even stillbirth from hypoxemia. Although estimating fetal weight can be done accurately, the issue of which fetal weight centile chart should be used continues to be a contentious topic. The arguments against local fetal growth charts based on national borders and customization for variables known to be associated with disease are substantial. As for other human diseases such as hypertension and diabetes, there is a rationale for the use of an international fetal growth reference standard. Irrespective of the choice of fetal growth reference standard, a significant limitation of small for gestational age (SGA) detection programs to prevent stillbirth is that the majority of stillborn infants at term were not SGA at the time of demise.

Summary Placental dysfunction can present with SGA from malnutrition and/or stillbirth from hypoxemia depending on the gestational age of onset. Emerging data show that at term, fetal Doppler arterial redistribution is associated more strongly with perinatal death than fetal size. Properly conducted trials of the role for maternal characteristics, fetal size, placental biomarkers, and Doppler assessing fetal well-being are required urgently.

aDepartment of Obstetrics and Gynaecology, St. George Hospital University Medical Center, Beirut, Lebanon

bDepartment of Obstetrics and Gynaecology, FMU, Spirito Santo Tertiary Level Hospital of Pescara, Pescara, Italy

cDepartment of Obstetrics and Gynaecology, Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, United Kingdom

Correspondence to Basky Thilaganathan, MD, PhD, FRCOG, Department of Obstetrics and Gynaecology, Fetal Medicine Unit, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0QT, United Kingdom. E-mail: basky@pobox.com

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