{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T20:29:34Z","timestamp":1793132974001,"version":"4.5.0"},"reference-count":33,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T00:00:00Z","timestamp":1764979200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T00:00:00Z","timestamp":1764979200000},"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; Gyne"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To develop predictive models for fetal growth restriction (FGR) with and without the inclusion of OxNNet\u2010derived first\u2010trimester placental volume (FTPV), thereby evaluating the contribution of FTPV to these models and the extent to which FTPV percentile is associated with subsequent FGR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study utilized data from the First\u2010trimester Placental Ultrasound (FirstPLUS) study, a longitudinal observational cohort study conducted at King's College Hospital NHS Foundation Trust, London, UK, between March and November 2022. Participants underwent routine ultrasound assessment between 11\u2009+\u20092 and 14\u2009+\u20091\u2009weeks' gestation, in addition to three\u2010dimensional placental sonography. The OxNNet toolkit was used for automated placental segmentation and volume calculation. Multivariable logistic regression models were developed to predict FGR, incorporating maternal factors, first\u2010trimester biomarkers (serum pregnancy\u2010associated plasma protein\u2010A, mean arterial blood pressure and uterine artery pulsatility index) and FTPV.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The final cohort comprised 3500 pregnancies, of which 250 (7.1%) developed FGR. Low FTPV was found to be a risk factor for FGR, with an odds ratio of 1.736 (95%\u2009CI, 1.499\u20132.015) per unit decrease in FTPV\n                      <jats:italic>Z<\/jats:italic>\n                      \u2010score. Incorporating FTPV into the predictive model based on maternal factors and biomarkers significantly increased the area under the receiver\u2010operating\u2010characteristics curve (AUC) for predicting all cases of FGR, from 0.78 (95%\u2009CI, 0.75\u20130.81) to 0.79 (95%\u2009CI, 0.76\u20130.82) (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.005). Subgroup analysis of normotensive and hypertensive cases demonstrated a statistically significant effect size for the prediction of FGR by FTPV\n                      <jats:italic>Z<\/jats:italic>\n                      \u2010score in both groups. The addition of FTPV to the model based on maternal factors and biomarkers for the prediction of normotensive FGR increased the AUC from 0.77 (95%\u2009CI, 0.74\u20130.80) to 0.78 (95%\u2009CI, 0.75\u20130.81) (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.01). For preterm FGR, the AUC was 0.85 (95%\u2009CI, 0.78\u20130.92) with FTPV and 0.85 (95%\u2009CI, 0.79\u20130.92) without (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.93); the absence of a significant difference may be due to a lack of power.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      FTPV\n                      <jats:italic>Z<\/jats:italic>\n                      \u2010score is a predictor of FGR. Integrating FTPV into predictive models significantly enhanced the discriminative ability for all cases of FGR, as well as for the subgroup of normotensive FGR. \u00a9 2025 The Author(s).\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.70146","type":"journal-article","created":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T22:03:58Z","timestamp":1765058638000},"page":"49-59","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["First\u2010trimester Placental Ultrasound (\n                    <scp>FirstPLUS<\/scp>\n                    ) study: prediction of fetal growth restriction using\n                    <scp>OxNNet<\/scp>\n                    \u2010derived first\u2010trimester placental volume"],"prefix":"10.1002","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1609-3654","authenticated-orcid":false,"given":"S.","family":"Mathewlynn","sequence":"first","affiliation":[{"name":"Nuffield Department of Women's and Reproductive Health University of Oxford  Oxford UK"},{"name":"Oxford University Hospitals NHS Foundation Trust  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3564-9072","authenticated-orcid":false,"given":"L. Nicolatino","family":"Starck","sequence":"additional","affiliation":[{"name":"Fetal Medicine Research Institute, King's College Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Wright","sequence":"additional","affiliation":[{"name":"Institute of Health Research University of Exeter  Exeter UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5821-7497","authenticated-orcid":false,"given":"Y.","family":"Yin","sequence":"additional","affiliation":[{"name":"Nuffield Department of Women's and Reproductive Health University of Oxford  Oxford UK"},{"name":"University of Bristol  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9889-4369","authenticated-orcid":false,"given":"M.","family":"Soltaninejad","sequence":"additional","affiliation":[{"name":"Nuffield Department of Women's and Reproductive Health University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1266-0711","authenticated-orcid":false,"given":"K. H.","family":"Nicolaides","sequence":"additional","affiliation":[{"name":"Fetal Medicine Research Institute, King's College Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5856-6072","authenticated-orcid":false,"given":"A.","family":"Syngelaki","sequence":"additional","affiliation":[{"name":"Fetal Medicine Research Institute, King's College Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. 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