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Title: Prediction of small-for-gestational-age neonates at 30-34 weeks' gestation
Author: Bakalis, S.
ISNI:       0000 0004 7660 0221
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2016
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Small-for-gestational-age (SGA) fetuses and neonates are at increased risk of perinatal mortality and morbidity. There is evidence that these risks are reduced in cases identified antenatally, through close monitoring, timely delivery and prompt neonatal management, compared to those not detected. The current method of antenatal screening for SGA fetuses is by maternal characteristics and medical history and serial measurements of symphysis fundal height, but the performance of this method is poor. This thesis aims to develop a model for the prediction of SGA neonates based on maternal characteristics, history, fetal biometry, uterine artery pulsatility index (PI), mean arterial pressure (MAP), and serum biochemical markers at 30-34 weeks' gestation (mean gestation at screening 32.3 weeks, IQR 32.0-32.9). The thesis also aims to examine the value of umbilical artery PI and fetal middle cerebral artery in the prediction of adverse perinatal outcome. This screening study included biophysical measurements in 30,849 singleton pregnancies at 30-34 weeks with 1,727 (5.6%) that delivered SGA neonates. A subset of 9,003 cases with 469 (5.2%) delivering SGA neonates had biophysical and biochemical measurements recorded. The best prediction was provided by a combination of maternal factors, estimated fetal weight (EFW), uterine artery PI, MAP and serum placental growth factor (PlGF). This combination predicted, at 10% false positive rate, 89%, 94%, 96% of SGA neonates delivering at 32-36 weeks' gestation with BW < 10th, < 5th and < 3rd centiles, respectively; the respective detection rates for SGA neonates delivering at > 37 weeks were 57%, 65% and 72%. The use of umbilical artery PI and MCA in the prediction of adverse perinatal outcome was found to be poor. In conclusion, combined screening by maternal factors and biophysical and biochemical markers at 30-34 weeks' gestation can identify a high proportion of pregnancies that subsequently deliver SGA neonates.
Supervisor: Nicolaides, K. H. ; Peebles, D. M. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available