{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T20:02:15Z","timestamp":1782590535314,"version":"3.54.5"},"reference-count":31,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2021,6,2]],"date-time":"2021-06-02T00:00:00Z","timestamp":1622592000000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100007607","name":"University Research Council, Aga Khan University","doi-asserted-by":"publisher","award":["172005PAED"],"award-info":[{"award-number":["172005PAED"]}],"id":[{"id":"10.13039\/100007607","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":[[2021,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare the proportion of small\u2010for\u2010gestational\u2010age (SGA) infants detected by routine third\u2010trimester ultrasound <jats:italic>vs<\/jats:italic> those detected by selective ultrasound based on serial symphysis\u2013fundus height (SFH) measurements (standard care) in low\u2010risk pregnancy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was an open\u2010label randomized controlled trial conducted at a hospital in Kenya between May 2018 and February 2020. Low\u2010risk pregnant women were randomly allocated (ratio of 1:1) to routine ultrasound for fetal growth assessment between 36\u2009+\u20090 and 37\u2009+\u20096\u2009weeks' gestation (intervention group) or to standard care, which involved a selective growth scan on clinical suspicion of fetal growth abnormality based on serial SFH measurements (control group). During ultrasound examination, fetal growth was assessed by measurement of the abdominal circumference (AC), and AC &lt;\u200910<jats:sup>th<\/jats:sup> centile was used to diagnose a SGA fetus. The main prespecified outcomes were the detection of neonatal SGA, defined as birth weight &lt;\u200910<jats:sup>th<\/jats:sup> centile, and of severe neonatal SGA, defined as birth weight &lt;\u20093<jats:sup>rd<\/jats:sup> centile. The predictive performance of routine third\u2010trimester ultrasound and selective ultrasound based on serial SFH measurements was determined using receiver\u2010operating\u2010characteristics (ROC)\u2010curve analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 566 women assessed for eligibility, 508 (89.8%) were randomized, of whom 253 were allocated to the intervention group and 255 to the control group. Thirty\u2010six babies in the intervention group and 26 in the control group had a birth weight &lt;\u200910<jats:sup>th<\/jats:sup> centile. The detection rate of SGA infants by routine third\u2010trimester ultrasound <jats:italic>vs<\/jats:italic> that by standard care was 52.8% (19\/36) <jats:italic>vs<\/jats:italic> 7.7% (2\/26) (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and the specificity was 95.5% (191\/200) and 97.9% (191\/195), respectively (<jats:italic>P<\/jats:italic>\u2009=\u20090.08). The detection rate of severe SGA was 66.7% (12\/18) by routine ultrasound <jats:italic>vs<\/jats:italic> 8.3% (1\/12) by selective ultrasound based on SFH measurements (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), with specificities of 91.7% (200\/218) and 98.1% (205\/209), respectively (<jats:italic>P<\/jats:italic>\u2009=\u20090.006). The area under the ROC curve of routine third\u2010trimester ultrasound in prediction of SGA was significantly greater than that of selective ultrasound based on SFH measurements (0.92 (95%\u2009CI, 0.87\u20130.96) <jats:italic>vs<\/jats:italic> 0.68 (95%\u2009CI, 0.58\u20130.77); <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In low\u2010risk pregnancy, routine ultrasound performed between 36\u2009+\u20090 and 37\u2009+\u20096\u2009weeks is superior to selective ultrasound based on serial SFH measurements for the detection of true SGA, with high specificity. \u00a9 2021 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.23618","type":"journal-article","created":{"date-parts":[[2021,2,23]],"date-time":"2021-02-23T06:29:34Z","timestamp":1614061774000},"page":"910-916","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Routine third\u2010trimester ultrasound for the detection of small\u2010for\u2010gestational age in low\u2010risk pregnancies (<scp>ROTTUS<\/scp> study): randomized controlled trial"],"prefix":"10.1002","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6160-8720","authenticated-orcid":false,"given":"S. Z.","family":"Wanyonyi","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology Aga Khan University  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Orwa","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences Aga Khan University  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Ozelle","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Aga Khan University  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Martinez","sequence":"additional","affiliation":[{"name":"Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal\u2013Fetal and Neonatal Medicine, Hospital Cl\u00ednic and Hospital Sant Joan de D\u00e9u, Institut Cl\u00ednic de Ginecologia, Obstetr\u00edcia i Neonatologia University of Barcelona  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Atsali","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery Aga Khan University  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Vinayak","sequence":"additional","affiliation":[{"name":"Department of Radiology and Imaging Aga Khan University  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Temmerman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Aga Khan University  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Figueras","sequence":"additional","affiliation":[{"name":"Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal\u2013Fetal and Neonatal Medicine, Hospital Cl\u00ednic and Hospital Sant Joan de D\u00e9u, Institut Cl\u00ednic de Ginecologia, Obstetr\u00edcia i Neonatologia University of Barcelona  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,6,2]]},"reference":[{"key":"e_1_2_8_2_1","first-page":"CD001451","article-title":"Routine ultrasound in late pregnancy (after 24\u2009weeks' gestation)","volume":"6","author":"Bricker L","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_3_1","volume-title":"Antenatal care: (NICE clinical guideline 62)","author":"National Collaborating Centre for Women's and Children's Health (UK)","year":"2008"},{"key":"e_1_2_8_4_1","first-page":"273","article-title":"Routine ultrasound in low\u2010risk pregnancy. 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