Patient selection: fetus with intra-uterine growth retardation (IUGR), defined as an estimated weight by ultrasound below the 10th percentile using the Hadlock equation
Exclusion: known congenital anomalies, known chromosomal abnormalities, delivery at less than 25 weeks gestation
Parameters:
(1) response to non-stress test (NST)
(2) size for gestational age
(3) amniotic fluid index (AFI)
(4) arterial findings on Doppler ultrasonography
(5) venous flow on Doppler ultrasonography
|
Parameter
|
Finding
|
Points
|
|
response to NST
|
reactive
|
0
|
|
|
non-reactive
|
1
|
|
size for gestational age
|
small for gestational age
|
1
|
|
|
not small for gestational age
|
0
|
|
amniotic fluid index
|
< 50 mm
|
1
|
|
|
>= 50 mm
|
0
|
|
arterial findings
|
normal
|
0
|
|
|
shunting (diastolic flow in the middle cerebral artery)
|
1
|
|
|
absent diastolic flow
|
2
|
|
|
reverse diastolic flow
|
4
|
|
venous flow
|
normal
|
0
|
|
|
abnormal ductus venosus flow
|
1
|
|
|
reverse ductus venosus flow during A wave
|
3
|
|
|
umbilical vein pulsations
|
4
|
where:
• The fetuses were selected based on the presence of IUGR. This would mean that most if not all should be small for gestational age.
total score =
= SUM(points for the 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 11
• The higher the score the worse the fetal outcome.
• The score can be used in conjunction with the Biophysical Profile.
Performance:
• The area under the ROC curve was 0.8.
