{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T04:16:02Z","timestamp":1790136962620,"version":"4.0.1"},"reference-count":31,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T00:00:00Z","timestamp":1677628800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To develop and validate an index predictive of adverse perinatal outcome (APO) in pregnancies meeting the consensus\u2010based criteria for fetal growth restriction (FGR) endorsed by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective analysis of consecutive singleton non\u2010anomalous gestations meeting the ISUOG\u2010endorsed criteria for FGR at a single tertiary care center from November 2010 to August 2020. The dataset was divided randomly into a development set (two\u2010thirds) and a validation set (one\u2010third). The primary composite APO comprised one or more of: perinatal demise, Grade III\u2013IV intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), seizures, hypoxic ischemic encephalopathy (HIE), necrotizing enterocolitis (NEC), sepsis, bronchopulmonary dysplasia (BPD) and length of stay in the neonatal intensive care unit (NICU) &gt;\u20097\u2009days. Regression analysis incorporated clinical factors readily available at the time of FGR diagnosis. The sum of \u03b2 coefficient\u2010based weights yielded an index score, the performance of which was assessed in the validation set. Score cut\u2010offs were selected to identify \u2018high\u2010risk\u2019 and \u2018low\u2010risk\u2019 ranges for which positive (PPV) and negative (NPV) predictive values and positive (LR+) and negative (LR\u2013) likelihood ratios were calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 875 consecutive pregnancies that met the criteria for FGR and were included in the study cohort, 405 (46%) were complicated by one or more components of the composite APO, including 54 (6%) perinatal deaths, 22 (3%) neonates with Grade III\u2013IV IVH and\/or PVL, nine (1%) with seizures and\/or HIE, 91 (10%) with BPD, 57 (7%) with sepsis, 21 (2%) with NEC, and 361 (41%) who remained in the NICU &gt;\u20097\u2009days. In addition, 270 (31%) pregnancies were delivered by Cesarean section for non\u2010reassuring fetal status, 43 (5%) were admitted to the NICU for &lt;\u20097\u2009days, 79 (9%) had 5\u2010min Apgar score &lt;\u20097, 125\/631 (20%) had a cord gas pH \u2264\u20097.1 and 35\/631 (6%) had a base excess \u2265\u200912\u2009mmol\/L. The predictive index we developed included seven factors available at the time of FGR diagnosis: hypertensive disorder of pregnancy (HDP) (+8 points), chronic hypertension without HDP (+4 points), gestational age \u2264\u200932\u2009weeks (+5 points), absent or reversed end\u2010diastolic flow in the umbilical artery (+8 points), prepregnancy body mass index \u2265\u200935\u2009kg\/m<jats:sup>2<\/jats:sup> (+3 points), isolated abdominal circumference &lt;\u20093<jats:sup>rd<\/jats:sup>\u2009percentile (\u22124 points) and non\u2010Hispanic black race (\u22122 points). The bias\u2010corrected bootstrapped (1000 replicates) area under the receiver\u2010operating\u2010characteristics curve (AUC) of the predictive index for composite APO in the validation group was 0.88 (95%\u2009CI, 0.84\u20130.92), which was similar to that in the development group (AUC, 0.86 (95%\u2009CI, 0.82\u20130.89); <jats:italic>P\u2009=<\/jats:italic>\u20090.34). In the total cohort, 40% of pregnancies had a low\u2010risk index score (\u2264\u20092), associated with a NPV of 85% (95%\u2009CI, 81\u201388%) and a LR\u2013 of 0.21 (95%\u2009CI, 0.16\u20130.27), and 23% had a high\u2010risk index score (\u2265\u200910), associated with a PPV of 96% (95%\u2009CI, 93\u201398%) and a LR+ of 27.36 (95%\u2009CI, 14.33\u201352.23). Of the remaining pregnancies that had an intermediate\u2010risk score, 50% were complicated by composite APO.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>An easy\u2010to\u2010use index incorporating seven clinical factors readily available at the time of FGR diagnosis is predictive of APO and may prove useful in counseling and management of pregnancies meeting the ISUOG\u2010endorsed criteria for FGR. \u00a9 2022 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.26044","type":"journal-article","created":{"date-parts":[[2022,8,9]],"date-time":"2022-08-09T14:46:19Z","timestamp":1660056379000},"page":"367-376","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Predictive index for adverse perinatal outcome in pregnancies complicated by fetal growth restriction"],"prefix":"10.1002","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0061-3336","authenticated-orcid":false,"given":"J. E.","family":"Powel","sequence":"first","affiliation":[{"name":"Division of Maternal\u2013Fetal Medicine, Department of Obstetrics, Gynecology &amp; Women's Health Saint Louis University School of Medicine  St Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. W.","family":"Zantow","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2013Fetal Medicine, Department of Obstetrics, Gynecology &amp; Women's Health Saint Louis University School of Medicine  St Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. F.","family":"Bialko","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2013Fetal Medicine, Department of Obstetrics, Gynecology &amp; Women's Health Saint Louis University School of Medicine  St Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. 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