Predictive index for adverse perinatal outcome in pregnancies complicated by fetal growth restriction

ABSTRACT Objectives To develop and validate an index predictive of adverse perinatal outcome (APO) in pregnancies meeting the consensus‐based criteria for fetal growth restriction (FGR) endorsed by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG). Methods This was a retrospective analysis of consecutive singleton non‐anomalous gestations meeting the ISUOG‐endorsed criteria for FGR at a single tertiary care center from November 2010 to August 2020. The dataset was divided randomly into a development set (two‐thirds) and a validation set (one‐third). The primary composite APO comprised one or more of: perinatal demise, Grade III–IV intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), seizures, hypoxic ischemic encephalopathy (HIE), necrotizing enterocolitis (NEC), sepsis, bronchopulmonary dysplasia (BPD) and length of stay in the neonatal intensive care unit (NICU) > 7 days. Regression analysis incorporated clinical factors readily available at the time of FGR diagnosis. The sum of β coefficient‐based weights yielded an index score, the performance of which was assessed in the validation set. Score cut‐offs were selected to identify ‘high‐risk’ and ‘low‐risk’ ranges for which positive (PPV) and negative (NPV) predictive values and positive (LR+) and negative (LR–) likelihood ratios were calculated. Results Of the 875 consecutive pregnancies that met the criteria for FGR and were included in the study cohort, 405 (46%) were complicated by one or more components of the composite APO, including 54 (6%) perinatal deaths, 22 (3%) neonates with Grade III–IV IVH and/or PVL, nine (1%) with seizures and/or HIE, 91 (10%) with BPD, 57 (7%) with sepsis, 21 (2%) with NEC, and 361 (41%) who remained in the NICU > 7 days. In addition, 270 (31%) pregnancies were delivered by Cesarean section for non‐reassuring fetal status, 43 (5%) were admitted to the NICU for