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Detection of small for gestational age in preterm prelabor rupture of membranes by Hadlock versus the Fetal Medicine Foundation growth charts: a prospective cohort study
  • Jose Duncan,
  • Karla Leavitt,
  • Gustavo Vilchez
Jose Duncan
University of South Florida College of Medicine

Corresponding Author:[email protected]

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Karla Leavitt
University of South Florida College of Medicine
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Gustavo Vilchez
University of Missouri-Kansas City School of Medicine
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Objectives: Small for gestational age (SGA) neonates are at increased risk for adverse outcomes, which is also common in pregnancies with preterm prelabor rupture of membranes (PPROM). The primary outcome was to compare the diagnostic accuracy for neonatal SGA by the Hadlock and the FMF charts in our cohort, followed by the ability to predict composite severe neonatal outcomes. Methods: This study was a secondary analysis of a prospective cohort of pregnancies with PPROM from 2015 to 2018, from 23 to 36 completed weeks of gestation. Sensitivity, specificity, and positive and negative predictive values were compared as well as receiver operating curves (AUC). Results: Of the 106 women who met inclusion criteria, 48 (45%) screened positive with the FMF fetal growth chart and 22 (21%) screened positive with the Hadlock chart. SGA was diagnosed in 12 infants (11%). Both fetal growth charts had a comparable diagnostic accuracy and were statistically significant predictors of SGA, Hadlock: AUC: 0.76, RR 7.6 95% CI (2.5- 23), FMF: AUC: 0.76 RR 1.8-13.3 95% CI (1.8 – 99.3). Both growth standards were poor predictors of severe neonatal outcomes. Conclusion: The Hadlock and the FMF fetal growth charts are accurate predictors of SGA in pregnancies complicated by PPROM. The FMF fetal growth chart may result in a two-fold increase of positive screens, potentially increasing fetal surveillance. We acknowledge the need for more diverse studies to corroborate our results and identify the optimal fetal growth standard to detect SGA and severe neonatal outcomes in pregnancies with PPROM.