{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T19:09:53Z","timestamp":1792609793919,"version":"4.5.0"},"reference-count":45,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,11,6]],"date-time":"2023-11-06T00:00:00Z","timestamp":1699228800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2023,11,6]],"date-time":"2023-11-06T00:00:00Z","timestamp":1699228800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Fetal growth surveillance includes assessment of size as well as rate of growth, and various definitions for slow growth have been adopted into clinical use. The aim of this study was to evaluate the effectiveness of different models to identify stillbirth risk, in addition to risk represented by the fetus being small\u2010for\u2010gestational age (SGA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This was a retrospective analysis of a routinely collected and anonymized dataset of pregnancies that had two or more third\u2010trimester ultrasound measurements of estimated fetal weight (EFW). SGA was defined as EFW &lt;\u200910\n                      <jats:sup>th<\/jats:sup>\n                      customized centile, and slow growth was defined according to five published models in clinical use: (1) a fixed velocity limit of 20\u2009g per day (FVL\n                      <jats:sub>20<\/jats:sub>\n                      ); (2) a fixed &gt;\u200950 centile drop, regardless of scan\u2010measurement interval (FCD\n                      <jats:sub>50<\/jats:sub>\n                      ); (3) a fixed &gt;\u200930 centile drop, regardless of scan interval (FCD\n                      <jats:sub>30<\/jats:sub>\n                      ); (4) growth trajectory slower than the third customized growth\u2010centile limit (GCL\n                      <jats:sub>3<\/jats:sub>\n                      ); and (5) EFW at second scan below the projected optimal weight range (POWR), based on partial receiver\u2010operating\u2010characteristics\u2010curve\u2010derived\u00a0\u2009cut\u2010offs specific to the scan interval.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The study cohort consisted of 164\u2009718 pregnancies with 480\u2009592 third\u2010trimester ultrasound scans (mean\u2009\u00b1\u2009SD, 2.9\u2009\u00b1\u20090.9). The last two scans in each pregnancy were performed at an average gestational age of 33\u2009+\u20095 and 37\u2009+\u20091\u2009weeks. At the last scan, 12\u2009858 (7.8%) EFWs were SGA, and of these, 9359 were also SGA at birth (positive predictive value, 72.8%). The rate at which slow growth was defined varied considerably (FVL\n                      <jats:sub>20<\/jats:sub>\n                      , 12.7%; FCD\n                      <jats:sub>50<\/jats:sub>\n                      , 0.7%; FCD\n                      <jats:sub>30<\/jats:sub>\n                      , 4.6%; GCL\n                      <jats:sub>3<\/jats:sub>\n                      , 19.8%; POWR, 10.1%), and there was varying overlap between cases identified as having slow growth and those identified as SGA at the last scan. Only the POWR method identified additional non\u2010SGA pregnancies with slow growth (11\u2009237\/16\u2009671 (67.4%)) that had significant stillbirth risk (relative risk, 1.58 (95% CI, 1.04\u20132.39)). These non\u2010SGA cases resulting in stillbirth had a median EFW centile of 52.6 at the last scan and a median weight centile of 27.3 at birth. Subgroup analysis identified methodological problems with the fixed\u2010velocity model because it assumes linear growth throughout gestation, and with the centile\u2010based methods because the non\u2010parametric distribution of centiles at the extremes does not reflect actual difference in weight gain.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Comparative analysis of five clinically used methods to define slow fetal growth has shown that only the measurement\u2010interval\u2010specific POWR model can identify non\u2010SGA fetuses with slow growth that are at increased risk of stillbirth. \u00a9 2023 The Authors.\n                      <jats:italic>Ultrasound in Obstetrics &amp; Gynecology<\/jats:italic>\n                      published by John Wiley &amp; Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.26248","type":"journal-article","created":{"date-parts":[[2023,5,16]],"date-time":"2023-05-16T08:59:49Z","timestamp":1684227589000},"page":"805-812","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Outcome\u2010based comparative analysis of five fetal growth velocity models to define slow growth"],"prefix":"10.1002","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3230-1292","authenticated-orcid":false,"given":"J.","family":"Gardosi","sequence":"first","affiliation":[{"name":"Perinatal Institute  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2106-214X","authenticated-orcid":false,"given":"O.","family":"Hugh","sequence":"additional","affiliation":[{"name":"Perinatal Institute  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,11,6]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2004.02.009"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38629.587639.7C"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2010.08.055"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajo.13283"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajo.12902"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.22187"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1515\/jpm-2022-0209"},{"key":"e_1_2_8_9_1","volume-title":"Evaluation of the implementation of the Saving Babies' Lives Care Bundle in early adopter NHS Trusts in England","author":"Widdows K","year":"2018"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f108"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1998.tb10153.x"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.24860"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/jp.2012.60"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.23111"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2015.1015981"},{"key":"e_1_2_8_16_1","unstructured":"NHS England.Saving Babies' Lives Version Two: A care bundle for reducing perinatal mortality.2019.https:\/\/www.england.nhs.uk\/wp\u2010content\/uploads\/2019\/03\/Saving\u2010Babies\u2010Lives\u2010Care\u2010Bundle\u2010Version\u2010Two\u2010Updated\u2010Final\u2010Version.pdf."},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.15884"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.22134"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.13522"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-017-0928-z"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-020-01869-3"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.22247"},{"key":"e_1_2_8_23_1","unstructured":"Perinatal Institute.GROW 2.0 Gestation Related Optimal Weight software v2.0.2022.https:\/\/www.perinatal.org.uk\/GROW2.0\/."},{"key":"e_1_2_8_24_1","unstructured":"Perinatal Institute.Fetal growth rate calculator.2022.https:\/\/www.perinatal.org.uk\/growthrate."},{"key":"e_1_2_8_25_1","unstructured":"RCOG.Green Top Guideline No 31. 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