© 1989 by Thieme Medical Publishers, Inc.
Sonographic Diagnosis of Intrauterine Growth Retardation Using the Postnatal Ponderal Index and the Crown-Heel Length as Standards of Diagnosis
04 March 2008 (online)
One hundred twenty-one patients underwent an ultrasound examination within 48 hours of delivery to assess prospectively the reliability of the diagnosis of intrauterine growth retardation. Sonographic parameters examined included the abdominal circumference, sonographic estimate of fetal weight, the head to abdominal circumference ratio, and the femur length to abdominal circumference ratio. The best obstetric estimate of gestational age was used. The diagnosis of growth retardation was based on the postnatal ponderal index, and or the birthweight and crown-heel length percentiles. Seventeen infants were growth retarded. Fifteen infants had a birthweight less than the 10th percentile, but only nine (60%) were either asymmetrically growth retarded (by their ponderal index) or symmetrically growth retarded (by virtue of a birthweight and length less than the 10th percentile). All sonographic parameters were better able to predict a birthweight below the 10th percentile for gestational age than growth retardation. An abdominal circumference less than the 2.5 percentile for gestational age had the highest sensitivity for growth retardation (88.0%) of the parameters studied. Only the abdominal circumference centile identified all infants with either symmetric growth retardation or asymmetric growth retardation associated with a birthweight below the 10th percentile. A sonographic estimate of fetal weight below the 10th percentile had the highest positive predictive value for growth retardation-38%. In contrast to the overall poor positive predictive values, the negative predictive values for all parameters studied exceeded 90%. Combining the abdominal circumference percentile with one of the three remaining techniques did not significantly improve diagnostic accuracy. We conclude that the abdominal circumference percentile is the best screening parameter for growth retardation, but that none of the studied parameters are specific enough to rely on for the diagnosis of mild degrees of growth retardation.