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INTRAUTERINE GROWTH RESTRICTION |
Lancet. 1992 Feb 1;339(8788):283-7.
Customised antenatal growth charts.
Gardosi J, Chang A, Kalyan B, Sahota D, Symonds EM.
Department of Obstetrics and Gynaecology, Queen's Medical Centre,
Nottingham, UK.
Charts for fetal growth do not take physiological variables into account. We
have therefore designed a computer-generated antenatal chart that can be
easily "customised" for each individual pregnancy, taking the mother's
characteristics and birthweights from previous pregnancies into
consideration. The adjusted birthweight range expected at 40 weeks'
gestation is combined with a standard, longitudinal ultrasound-derived curve
for intrauterine weight gain. Review at the Queen's Medical Centre,
Nottingham, UK, of 4179 pregnancies with ultrasound-confirmed dates showed
that, in addition to gestation and sex, maternal weight at first
antenatal-clinic visit, height, ethnic group, and parity were significant
determinants of birthweight in our population. Correction factors were
calculated for each of these variables and entered into a computer program
to adjust the normal birthweight centile limits. With adjusted centiles we
found that 28% of babies conventionally designated small for gestational age
(less than 10th centile) and 22% of those designated large (greater than
90th centile) were in fact within normal limits for the pregnancy.
Conversely, 24% and 26% of babies identified as small or large,
respectively, with adjusted centiles were "missed" by conventional
unadjusted centile assessment. Adjustment for physiological variables will
make assessment of fetal growth more precise and reduce unnecessary
investigations, interventions, and parental anxiety.
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