{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T02:19:33Z","timestamp":1789784373774,"version":"4.0.1"},"reference-count":27,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,7,23]],"date-time":"2019-07-23T00:00:00Z","timestamp":1563840000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100003123","name":"Fetal Medicine Foundation","doi-asserted-by":"publisher","award":["Charity No: 1037116"],"award-info":[{"award-number":["Charity No: 1037116"]}],"id":[{"id":"10.13039\/501100003123","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>First, to evaluate and compare the performance of routine ultrasonographic estimated fetal weight (EFW) and fetal abdominal circumference (AC) at 31\u2009+\u20090 to 33\u2009+\u20096 and 35\u2009+\u20090 to 36\u2009+\u20096\u2009weeks' gestation in the prediction of a large\u2010for\u2010gestational\u2010age (LGA) neonate born at \u2265\u200937\u2009weeks' gestation. Second, to assess the additive value of fetal growth velocity between 32 and 36\u2009weeks' gestation to the performance of EFW at 35\u2009+\u20090 to 36\u2009+\u20096\u2009weeks' gestation for prediction of a LGA neonate. Third, to define the predictive performance for a LGA neonate of different EFW cut\u2010offs on routine ultrasound examination at 35\u2009+\u20090 to 36\u2009+\u20096\u2009weeks' gestation. Fourth, to propose a two\u2010stage strategy for identifying pregnancies with a LGA fetus that may benefit from iatrogenic delivery during the 38<jats:sup>th<\/jats:sup> gestational week.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective study. First, data from 21\u2009989 singleton pregnancies that had undergone routine ultrasound examination at 31\u2009+\u20090 to 33\u2009+\u20096\u2009weeks' gestation and 45\u2009847 that had undergone routine ultrasound examination at 35\u2009+\u20090 to 36\u2009+\u20096\u2009weeks were used to compare the predictive performance of EFW and AC for a LGA neonate with birth weight &gt;\u200990<jats:sup>th<\/jats:sup> and &gt;\u200997<jats:sup>th<\/jats:sup> percentiles born at \u2265\u200937\u2009weeks' gestation. Second, data from 14\u2009497 singleton pregnancies that had undergone routine ultrasound examination at 35\u2009+\u20090 to 36\u2009+\u20096\u2009weeks' gestation and had a previous scan at 30\u2009+\u20090 to 34\u2009+\u20096\u2009weeks were used to determine, through multivariable logistic regression analysis, whether addition of growth velocity, defined as the difference in EFW <jats:italic>Z<\/jats:italic>\u2010score or AC <jats:italic>Z<\/jats:italic>\u2010score between the early and late third\u2010trimester scans divided by the time interval between the scans, improved the performance of EFW at 35\u2009+\u20090 to 36\u2009+\u20096\u2009weeks in the prediction of delivery of a LGA neonate at \u2265\u200937\u2009weeks' gestation. Third, in the database of the 45\u2009847 pregnancies that had undergone routine ultrasound examination at 35\u2009+\u20090 to 36\u2009+\u20096\u2009weeks' gestation, the screen\u2010positive and detection rates for a LGA neonate born at \u2265\u200937\u2009weeks' gestation and \u2264\u200910\u2009days after the initial scan were calculated for  different EFW percentile cut\u2010offs between the 50<jats:sup>th<\/jats:sup> and 90<jats:sup>th<\/jats:sup> percentiles.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>First, the areas under the receiver\u2013operating characteristics curves (AUC) of screening for a LGA neonate were significantly higher using EFW <jats:italic>Z<\/jats:italic>\u2010score than AC <jats:italic>Z<\/jats:italic>\u2010score and at 35\u2009+\u20090 to 36\u2009+\u20096 than at 31\u2009+\u20090 to 33\u2009+\u20096\u2009weeks' gestation (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001 for all). Second, the performance of screening for a LGA neonate achieved by EFW <jats:italic>Z<\/jats:italic>\u2010score at 35\u2009+\u20090 to 36\u2009+\u20096\u2009weeks was not significantly improved by addition of EFW growth velocity or AC growth velocity. Third, in screening by EFW &gt;\u200990<jats:sup>th<\/jats:sup> percentile at 35\u2009+\u20090 to 36\u2009+\u20096\u2009weeks' gestation, the predictive performance for a LGA neonate born at \u2265\u200937\u2009weeks' gestation was modest (65% and 46% for neonates with birth weight &gt;\u200997<jats:sup>th<\/jats:sup> and &gt;\u200990<jats:sup>th<\/jats:sup> percentiles, respectively, at a screen\u2010positive rate of 10%), but the performance was better for prediction of a LGA neonate born \u2264\u200910\u2009days after the scan (84% and 71% for neonates with birth weight &gt;\u200997<jats:sup>th<\/jats:sup> and &gt;\u200990<jats:sup>th<\/jats:sup> percentiles, respectively, at a screen\u2010positive rate of 11%). Fourth, screening by EFW &gt;\u200970<jats:sup>th<\/jats:sup> percentile at 35\u2009+\u20090 to 36\u2009+\u20096\u2009weeks' gestation predicted 91% and 82% of LGA neonates with birth weight &gt;\u200997<jats:sup>th<\/jats:sup> and &gt;\u200990<jats:sup>th<\/jats:sup> percentiles, respectively, born at \u2265\u200937\u2009weeks' gestation, at a screen\u2010positive rate of 32%, and the respective values of screening by EFW &gt;\u200985<jats:sup>th<\/jats:sup> percentile for prediction of a LGA neonate born \u2264\u200910\u2009days after the scan were 88%, 81% and 15%. On the basis of these results, it was proposed that routine fetal biometry at 36\u2009weeks' gestation is a screening rather than diagnostic test for fetal macrosomia and that EFW &gt;\u200970<jats:sup>th<\/jats:sup> percentile should be used to identify pregnancies in need of another scan at 38\u2009weeks, at which those with EFW &gt;\u200985<jats:sup>th<\/jats:sup> percentile should be considered for iatrogenic delivery during the 38<jats:sup>th<\/jats:sup>\u2009week.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>First, the predictive performance for a LGA neonate by routine ultrasonographic examination during the third trimester is higher if the scan is carried out at 36 than at 32\u2009weeks, the method of screening is EFW than fetal AC, the outcome measure is birth weight &gt;\u200997<jats:sup>th<\/jats:sup> than &gt;\u200990<jats:sup>th<\/jats:sup> percentile and if delivery occurs within 10\u2009days than at any stage after assessment. Second, prediction of a LGA neonate by EFW &gt;\u200990<jats:sup>th<\/jats:sup> percentile is modest and this study presents a two\u2010stage strategy for maximizing the prenatal prediction of a LGA neonate. Copyright \u00a9 2019 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.20377","type":"journal-article","created":{"date-parts":[[2019,6,25]],"date-time":"2019-06-25T19:48:55Z","timestamp":1561492135000},"page":"326-333","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":74,"title":["Prediction of large\u2010for\u2010gestational\u2010age neonate by routine third\u2010trimester ultrasound"],"prefix":"10.1002","volume":"54","author":[{"given":"N.","family":"Khan","sequence":"first","affiliation":[{"name":"Fetal Medicine Unit Medway Maritime Hospital  Gillingham UK"},{"name":"Institute of Medical Sciences Canterbury Christ Church University  Chatham UK"},{"name":"Fetal Medicine Research Institute King's College Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Ciobanu","sequence":"additional","affiliation":[{"name":"Fetal Medicine Research Institute King's College Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Karampitsakos","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit Medway Maritime Hospital  Gillingham UK"},{"name":"Institute of Medical Sciences Canterbury Christ Church University  Chatham UK"},{"name":"Fetal Medicine Research Institute King's College Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7265-5442","authenticated-orcid":false,"given":"R.","family":"Akolekar","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit Medway Maritime Hospital  Gillingham UK"},{"name":"Institute of Medical Sciences Canterbury Christ Church University  Chatham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. 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