Ultrasound screening for fetal growth restriction at 36 vs 32 weeks' gestation: a randomized trial (ROUTE)
Objective To compare the utility of routine third‐trimester ultrasound examination at 36 weeks' gestation with that at 32 weeks in detecting fetal growth restriction (FGR). Methods This was an open‐label parallel randomized trial (ROUTE study) conducted at a single general hospital serving a ge...
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| Veröffentlicht in: | Ultrasound in obstetrics & gynecology 2015-10, Vol.46 (4), p.391-397 |
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| container_title | Ultrasound in obstetrics & gynecology |
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| creator | Roma, E. Arnau, A. Berdala, R. Bergos, C. Montesinos, J. Figueras, F. |
| description | Objective
To compare the utility of routine third‐trimester ultrasound examination at 36 weeks' gestation with that at 32 weeks in detecting fetal growth restriction (FGR).
Methods
This was an open‐label parallel randomized trial (ROUTE study) conducted at a single general hospital serving a geographically well‐defined catchment area in Barcelona, Spain, between May 2011 and April 2014. Women with no adverse medical or obstetric history and a singleton pregnancy without fetal abnormalities at routine second‐trimester scan were assigned randomly to undergo a scan at 32 weeks' gestation (n = 1272) or at 36 weeks' gestation (n = 1314). Primary outcome measures were detection rates of FGR (customized birth weight |
| doi_str_mv | 10.1002/uog.14915 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1718910830</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1718910830</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3255-6bea36f28733bbac688b22bb6902f92ee6e7a3947f1ae3262188cb31c5415473</originalsourceid><addsrcrecordid>eNp1kD1PwzAQQC0EoqUw8AeQN9ohrT8SJ2ZDVSlIlSqhdo6c5BICSVzshKpMrPxNfgkpKWxMN9y7p9ND6JKSMSWETRqdjakrqXeE-tQV0iE-8Y5Rn0hBHF9I1kNn1j4TQoTLxSnqMUE45VL2UbEuaqOsbqoE29gAVHmV4VQbnEKtCpwZva2fsAFbmzyuc11hVWMu8JvFnH19fG4BXuw1zlpA7dc3WGGjqkSX-TskuL1qLcPH5Xo1G52jk1QVFi4Oc4BWd7PV9N5ZLOcP09uFE3PmeY6IQHGRssDnPIpULIIgYiyKhCQslQxAgK-4dP2UKuBMMBoEccRp7LnUc30-QMNOuzH6tWkfC8vcxlAUqgLd2JD6NJCUBJy06KhDY6OtNZCGG5OXyuxCSsJ927BtG_60bdmrg7aJSkj-yN-YLTDpgG1ewO5_U7hezjvlN6pig0E</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1718910830</pqid></control><display><type>article</type><title>Ultrasound screening for fetal growth restriction at 36 vs 32 weeks' gestation: a randomized trial (ROUTE)</title><source>Wiley Online Library - AutoHoldings Journals</source><source>MEDLINE</source><source>Wiley Online Library Free Content</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Roma, E. ; Arnau, A. ; Berdala, R. ; Bergos, C. ; Montesinos, J. ; Figueras, F.</creator><creatorcontrib>Roma, E. ; Arnau, A. ; Berdala, R. ; Bergos, C. ; Montesinos, J. ; Figueras, F.</creatorcontrib><description>Objective
To compare the utility of routine third‐trimester ultrasound examination at 36 weeks' gestation with that at 32 weeks in detecting fetal growth restriction (FGR).
Methods
This was an open‐label parallel randomized trial (ROUTE study) conducted at a single general hospital serving a geographically well‐defined catchment area in Barcelona, Spain, between May 2011 and April 2014. Women with no adverse medical or obstetric history and a singleton pregnancy without fetal abnormalities at routine second‐trimester scan were assigned randomly to undergo a scan at 32 weeks' gestation (n = 1272) or at 36 weeks' gestation (n = 1314). Primary outcome measures were detection rates of FGR (customized birth weight < 10th centile) and severe FGR (customized birth weight < 3rd centile).
Results
There were no significant differences in perinatal outcome between those who underwent a scan at 32 weeks' gestation and those who underwent a scan at 36 weeks' gestation. Severe FGR at birth was associated significantly with emergency Cesarean delivery for fetal distress (odds ratio (OR), 3.4 (95% CI, 1.8–6.7)), neonatal admission (OR, 2.23 (95% CI, 1.23–4.05)), hypoglycemia (OR, 9.5 (95% CI, 1.8–49.8)) and hyperbilirubinemia (OR, 9.0 (95% CI, 4.6–17.6)). Despite similar false‐positive rates (FPRs) (6.4% vs 8.2%), FGR detection rates were superior at 36 vs 32 weeks' gestation (sensitivity, 38.8% vs 22.5%; P = 0.006), with positive and negative likelihood ratios of 6.1 vs 2.7 and 0.65 vs 0.84, respectively. In cases of severe FGR, FPRs for both scans were also similar (8.5% vs 8.7%), but detection rates were superior at 36 vs 32 weeks' gestation (61.4% vs 32.5%; P = 0.008). Positive and negative likelihood ratios were 7.2 vs 3.7 and 0.4 vs 0.74, respectively.
Conclusion
In low‐risk pregnancies, routine ultrasound examination at 36 weeks' gestation was more effective than that at 32 weeks' gestation in detecting FGR and related adverse perinatal and neonatal outcomes. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
This article has been selected for Journal Club. Click here to view slides and discussion points.</description><identifier>ISSN: 0960-7692</identifier><identifier>EISSN: 1469-0705</identifier><identifier>DOI: 10.1002/uog.14915</identifier><identifier>PMID: 26031399</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Adult ; Birth Weight - physiology ; Female ; fetal development ; fetal growth restriction ; Fetal Growth Retardation - diagnostic imaging ; Gestational Age ; Humans ; Hyperbilirubinemia, Neonatal - epidemiology ; Male ; neonatal complications ; placenta ; Pregnancy ; Pregnancy Outcome ; ultrasonography ; Ultrasonography, Doppler, Color - methods ; Ultrasonography, Prenatal - methods ; Umbilical Arteries - diagnostic imaging</subject><ispartof>Ultrasound in obstetrics & gynecology, 2015-10, Vol.46 (4), p.391-397</ispartof><rights>Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3255-6bea36f28733bbac688b22bb6902f92ee6e7a3947f1ae3262188cb31c5415473</citedby><cites>FETCH-LOGICAL-c3255-6bea36f28733bbac688b22bb6902f92ee6e7a3947f1ae3262188cb31c5415473</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fuog.14915$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fuog.14915$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,1427,27903,27904,45553,45554,46388,46812</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26031399$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Roma, E.</creatorcontrib><creatorcontrib>Arnau, A.</creatorcontrib><creatorcontrib>Berdala, R.</creatorcontrib><creatorcontrib>Bergos, C.</creatorcontrib><creatorcontrib>Montesinos, J.</creatorcontrib><creatorcontrib>Figueras, F.</creatorcontrib><title>Ultrasound screening for fetal growth restriction at 36 vs 32 weeks' gestation: a randomized trial (ROUTE)</title><title>Ultrasound in obstetrics & gynecology</title><addtitle>Ultrasound Obstet Gynecol</addtitle><description>Objective
To compare the utility of routine third‐trimester ultrasound examination at 36 weeks' gestation with that at 32 weeks in detecting fetal growth restriction (FGR).
Methods
This was an open‐label parallel randomized trial (ROUTE study) conducted at a single general hospital serving a geographically well‐defined catchment area in Barcelona, Spain, between May 2011 and April 2014. Women with no adverse medical or obstetric history and a singleton pregnancy without fetal abnormalities at routine second‐trimester scan were assigned randomly to undergo a scan at 32 weeks' gestation (n = 1272) or at 36 weeks' gestation (n = 1314). Primary outcome measures were detection rates of FGR (customized birth weight < 10th centile) and severe FGR (customized birth weight < 3rd centile).
Results
There were no significant differences in perinatal outcome between those who underwent a scan at 32 weeks' gestation and those who underwent a scan at 36 weeks' gestation. Severe FGR at birth was associated significantly with emergency Cesarean delivery for fetal distress (odds ratio (OR), 3.4 (95% CI, 1.8–6.7)), neonatal admission (OR, 2.23 (95% CI, 1.23–4.05)), hypoglycemia (OR, 9.5 (95% CI, 1.8–49.8)) and hyperbilirubinemia (OR, 9.0 (95% CI, 4.6–17.6)). Despite similar false‐positive rates (FPRs) (6.4% vs 8.2%), FGR detection rates were superior at 36 vs 32 weeks' gestation (sensitivity, 38.8% vs 22.5%; P = 0.006), with positive and negative likelihood ratios of 6.1 vs 2.7 and 0.65 vs 0.84, respectively. In cases of severe FGR, FPRs for both scans were also similar (8.5% vs 8.7%), but detection rates were superior at 36 vs 32 weeks' gestation (61.4% vs 32.5%; P = 0.008). Positive and negative likelihood ratios were 7.2 vs 3.7 and 0.4 vs 0.74, respectively.
Conclusion
In low‐risk pregnancies, routine ultrasound examination at 36 weeks' gestation was more effective than that at 32 weeks' gestation in detecting FGR and related adverse perinatal and neonatal outcomes. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
This article has been selected for Journal Club. Click here to view slides and discussion points.</description><subject>Adult</subject><subject>Birth Weight - physiology</subject><subject>Female</subject><subject>fetal development</subject><subject>fetal growth restriction</subject><subject>Fetal Growth Retardation - diagnostic imaging</subject><subject>Gestational Age</subject><subject>Humans</subject><subject>Hyperbilirubinemia, Neonatal - epidemiology</subject><subject>Male</subject><subject>neonatal complications</subject><subject>placenta</subject><subject>Pregnancy</subject><subject>Pregnancy Outcome</subject><subject>ultrasonography</subject><subject>Ultrasonography, Doppler, Color - methods</subject><subject>Ultrasonography, Prenatal - methods</subject><subject>Umbilical Arteries - diagnostic imaging</subject><issn>0960-7692</issn><issn>1469-0705</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kD1PwzAQQC0EoqUw8AeQN9ohrT8SJ2ZDVSlIlSqhdo6c5BICSVzshKpMrPxNfgkpKWxMN9y7p9ND6JKSMSWETRqdjakrqXeE-tQV0iE-8Y5Rn0hBHF9I1kNn1j4TQoTLxSnqMUE45VL2UbEuaqOsbqoE29gAVHmV4VQbnEKtCpwZva2fsAFbmzyuc11hVWMu8JvFnH19fG4BXuw1zlpA7dc3WGGjqkSX-TskuL1qLcPH5Xo1G52jk1QVFi4Oc4BWd7PV9N5ZLOcP09uFE3PmeY6IQHGRssDnPIpULIIgYiyKhCQslQxAgK-4dP2UKuBMMBoEccRp7LnUc30-QMNOuzH6tWkfC8vcxlAUqgLd2JD6NJCUBJy06KhDY6OtNZCGG5OXyuxCSsJ927BtG_60bdmrg7aJSkj-yN-YLTDpgG1ewO5_U7hezjvlN6pig0E</recordid><startdate>201510</startdate><enddate>201510</enddate><creator>Roma, E.</creator><creator>Arnau, A.</creator><creator>Berdala, R.</creator><creator>Bergos, C.</creator><creator>Montesinos, J.</creator><creator>Figueras, F.</creator><general>John Wiley & Sons, Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201510</creationdate><title>Ultrasound screening for fetal growth restriction at 36 vs 32 weeks' gestation: a randomized trial (ROUTE)</title><author>Roma, E. ; Arnau, A. ; Berdala, R. ; Bergos, C. ; Montesinos, J. ; Figueras, F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3255-6bea36f28733bbac688b22bb6902f92ee6e7a3947f1ae3262188cb31c5415473</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Birth Weight - physiology</topic><topic>Female</topic><topic>fetal development</topic><topic>fetal growth restriction</topic><topic>Fetal Growth Retardation - diagnostic imaging</topic><topic>Gestational Age</topic><topic>Humans</topic><topic>Hyperbilirubinemia, Neonatal - epidemiology</topic><topic>Male</topic><topic>neonatal complications</topic><topic>placenta</topic><topic>Pregnancy</topic><topic>Pregnancy Outcome</topic><topic>ultrasonography</topic><topic>Ultrasonography, Doppler, Color - methods</topic><topic>Ultrasonography, Prenatal - methods</topic><topic>Umbilical Arteries - diagnostic imaging</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Roma, E.</creatorcontrib><creatorcontrib>Arnau, A.</creatorcontrib><creatorcontrib>Berdala, R.</creatorcontrib><creatorcontrib>Bergos, C.</creatorcontrib><creatorcontrib>Montesinos, J.</creatorcontrib><creatorcontrib>Figueras, F.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Ultrasound in obstetrics & gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Roma, E.</au><au>Arnau, A.</au><au>Berdala, R.</au><au>Bergos, C.</au><au>Montesinos, J.</au><au>Figueras, F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ultrasound screening for fetal growth restriction at 36 vs 32 weeks' gestation: a randomized trial (ROUTE)</atitle><jtitle>Ultrasound in obstetrics & gynecology</jtitle><addtitle>Ultrasound Obstet Gynecol</addtitle><date>2015-10</date><risdate>2015</risdate><volume>46</volume><issue>4</issue><spage>391</spage><epage>397</epage><pages>391-397</pages><issn>0960-7692</issn><eissn>1469-0705</eissn><abstract>Objective
To compare the utility of routine third‐trimester ultrasound examination at 36 weeks' gestation with that at 32 weeks in detecting fetal growth restriction (FGR).
Methods
This was an open‐label parallel randomized trial (ROUTE study) conducted at a single general hospital serving a geographically well‐defined catchment area in Barcelona, Spain, between May 2011 and April 2014. Women with no adverse medical or obstetric history and a singleton pregnancy without fetal abnormalities at routine second‐trimester scan were assigned randomly to undergo a scan at 32 weeks' gestation (n = 1272) or at 36 weeks' gestation (n = 1314). Primary outcome measures were detection rates of FGR (customized birth weight < 10th centile) and severe FGR (customized birth weight < 3rd centile).
Results
There were no significant differences in perinatal outcome between those who underwent a scan at 32 weeks' gestation and those who underwent a scan at 36 weeks' gestation. Severe FGR at birth was associated significantly with emergency Cesarean delivery for fetal distress (odds ratio (OR), 3.4 (95% CI, 1.8–6.7)), neonatal admission (OR, 2.23 (95% CI, 1.23–4.05)), hypoglycemia (OR, 9.5 (95% CI, 1.8–49.8)) and hyperbilirubinemia (OR, 9.0 (95% CI, 4.6–17.6)). Despite similar false‐positive rates (FPRs) (6.4% vs 8.2%), FGR detection rates were superior at 36 vs 32 weeks' gestation (sensitivity, 38.8% vs 22.5%; P = 0.006), with positive and negative likelihood ratios of 6.1 vs 2.7 and 0.65 vs 0.84, respectively. In cases of severe FGR, FPRs for both scans were also similar (8.5% vs 8.7%), but detection rates were superior at 36 vs 32 weeks' gestation (61.4% vs 32.5%; P = 0.008). Positive and negative likelihood ratios were 7.2 vs 3.7 and 0.4 vs 0.74, respectively.
Conclusion
In low‐risk pregnancies, routine ultrasound examination at 36 weeks' gestation was more effective than that at 32 weeks' gestation in detecting FGR and related adverse perinatal and neonatal outcomes. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
This article has been selected for Journal Club. Click here to view slides and discussion points.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>26031399</pmid><doi>10.1002/uog.14915</doi><tpages>7</tpages></addata></record> |
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| identifier | ISSN: 0960-7692 |
| ispartof | Ultrasound in obstetrics & gynecology, 2015-10, Vol.46 (4), p.391-397 |
| issn | 0960-7692 1469-0705 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1718910830 |
| source | Wiley Online Library - AutoHoldings Journals; MEDLINE; Wiley Online Library Free Content; EZB-FREE-00999 freely available EZB journals |
| subjects | Adult Birth Weight - physiology Female fetal development fetal growth restriction Fetal Growth Retardation - diagnostic imaging Gestational Age Humans Hyperbilirubinemia, Neonatal - epidemiology Male neonatal complications placenta Pregnancy Pregnancy Outcome ultrasonography Ultrasonography, Doppler, Color - methods Ultrasonography, Prenatal - methods Umbilical Arteries - diagnostic imaging |
| title | Ultrasound screening for fetal growth restriction at 36 vs 32 weeks' gestation: a randomized trial (ROUTE) |
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