Download PDF
Am J Perinatol 2010; 27(2): 173-180
DOI: 10.1055/s-0029-1234032
© Thieme Medical Publishers

The Use of Ultrasound to Detect Small-for-Gestational-Age Infants in Patients with Elevated Human Chorionic Gonadotropin on Maternal Serum Screening

Tamera Hatfield1 , Aaron B. Caughey2 , David C. Lagrew3 , Ryan Heintz1 , Judith H. Chung1
  • 1Department of Obstetrics and Gynecology, University of California, Irvine, Orange, California
  • 2Department of Obstetrics and Gynecology, University of California, San Francisco, San Francisco, California
  • 3Saddleback Memorial Medical Center, Laguna Hills, California
Further Information

Publication History

Publication Date:
09 September 2009 (online)

    Permissions and Reprints

ABSTRACT

We evaluated serial sonography for the antenatal detection of small-for-gestational-age (SGA) infants in pregnancies with elevated human chorionic gonadotropin (hCG) levels on midtrimester triple-marker screen. A retrospective cohort study was performed at Saddleback Memorial Medical Center where serial ultrasounds from 26 weeks to delivery are generally recommended for patients with hCG levels >2.0 Multiple of the Median (MoM). From 1999 to 2007, 659 subjects were identified for analysis. The incidence of intrauterine growth restriction (IUGR) and SGA were 5.2% and 7.3%, respectively. Antenatal ultrasound identified 31.3% of SGA infants. Compared with estimated fetal weight (EFW) <10th percentile alone, abdominal circumference (AC) <10th percentile improved the detection of SGA from 31.3% (95% confidence interval [CI], 18.7 to 46.3) to 35.4% (95% CI, 22.2 to 50.5). Using either EFW or AC further increased the sensitivity to 45.8% (95% CI, 31.4 to 60.8). The sensitivity for the detection of SGA was 100% when an EFW cutoff of 75% was used. Ultrasound can be used to detect SGA infants in patients with elevated hCG levels on midtrimester serum screening. A sonographic estimated fetal weight ≥75th percentile appears to be a safe cutoff to rule out all fetuses at risk for SGA.

KEYWORDS

Human chorionic gonadotropin - intrauterine growth restriction - small for gestational age - ultrasound

REFERENCES

  • 1 Chandra S, Scott H, Dodds L et al.. Unexplained elevated maternal serum a-fetoprotein.  Am J Obstet Gynecol. 2003;  189 775-781
    CrossrefPubMedGoogle Scholar
  • 2 Walton D L, Norem C T, Schoen E J, Ray G T, Colby C J. Second-trimester serum chorionic gonadotropin concentrations and complications and outcome of pregnancy.  N Engl J Med. 1999;  341 2033-2038
    CrossrefPubMedGoogle Scholar
  • 3 Gravett C P, Buckmaster J G, Watson P T, Gravett M G. Elevated second trimester maternal serum beta-HCG concentrations and subsequent adverse pregnancy outcome.  Am J Med Genet. 1992;  44 485-486
    CrossrefPubMedGoogle Scholar
  • 4 Gonen R, Perez R, David M, Dar H, Merksamer R, Sharf M. The association between unexplained second-trimester maternal serum hCG elevation and pregnancy complications.  Obstet Gynecol. 1992;  80 83-86
    PubMedGoogle Scholar
  • 5 Tanaka M, Natori M, Kohno H, Ishimoto H, Kobayashi T, Nozawa S. Fetal growth in patients with elevated maternal serum hcG levels.  Obstet Gynecol. 1993;  81 341-343
    PubMedGoogle Scholar
  • 6 Sorensen T K, Williams M A, Zingheim R W, Clement S J, Hickok D E. Elevated second-trimester human chorionic gonadotropin and subsequent pregnancy-induced hypertension.  Am J Obstet Gynecol. 1993;  169 834-838
    PubMedGoogle Scholar
  • 7 Onderoğlu L S, Kabukçu A. Elevated second trimester human chorionic gonadotropin level associated with adverse pregnancy outcome.  Int J Gynaecol Obstet. 1997;  56 245-249
    CrossrefPubMedGoogle Scholar
  • 8 Wolfe H M, Gross T L, Sokol R J. Recurrent small for gestational age birth: perinatal risks and outcomes.  Am J Obstet Gynecol. 1987;  157 288-293
    PubMedGoogle Scholar
  • 9 Gardosi J, Mul T, Mongelli M, Fagan D. Analysis of birthweight and gestational age in antepartum stillbirths.  Br J Obstet Gynaecol. 1998;  105 524-530
    CrossrefPubMedGoogle Scholar
  • 10 Barker D J. The developmental origins of adult disease.  J Am Coll Nutr. 2004;  23 588S-595S
    CrossrefPubMedGoogle Scholar
  • 11 Hadlock F P, Harrist R B, Sharman R S, Deter R L, Park S K. Estimation of fetal weight with the use of head, body, and femur measurements.  Am J Obstet Gynecol. 1985;  151 333-337
    CrossrefPubMedGoogle Scholar
  • 12 Hadlock F P, Harrist R B, Martinez-Poyer J. In utero analysis of fetal growth: a sonographic weight standard.  Radiology. 1991;  181 129-133
    CrossrefPubMedGoogle Scholar
  • 13 Chung J H, Boscardin W J, Garite T J, Lagrew D C, Porto M. Ethnic differences in birth weight by gestational age: at least a partial explanation for the Hispanic epidemiologic paradox?.  Am J Obstet Gynecol. 2003;  189 1058-1062
    CrossrefPubMedGoogle Scholar
  • 14 Chung J H, Garite T J, Kirk A M, Hollard A L, Wing D A, Lagrew D C. Intrinsic racial differences in the risk of cesarean delivery are not explained by differences in caregivers or hospital site of delivery.  Am J Obstet Gynecol. 2006;  194 1323-1328
    CrossrefPubMedGoogle Scholar
  • 15 Doubilet P M, Benson C B, Nadel A S, Ringer S A. Improved birth weight table for neonates developed from gestations dated by early ultrasonography.  J Ultrasound Med. 1997;  16 241-249
    PubMedGoogle Scholar
  • 16 American College of Obstetrics and Gynecology .Intrauterine growth restriction. ACOG Practice Bulletin, No. 12. Washington, DC; ACOG 2000
    PubMedGoogle Scholar
  • 17 Yaron Y, Jaffa A J, Har-Toov J, Lavi H, Legum C, Evans M I. Doppler velocimetry of the umbilical artery as a predictor of outcome in pregnancies characterized by elevated beta-subunit human chorionic gonadotropin.  Fetal Diagn Ther. 1997;  12 353-355
    CrossrefPubMedGoogle Scholar
  • 18 Merviel P, Müller F, Guibourdenche J et al.. Correlations between serum assays of human chorionic gonadotrophin (hCG) and human placental lactogen (hPL) and pre-eclampsia or intrauterine growth restriction (IUGR) among nulliparas younger than 38 years.  Eur J Obstet Gynecol Reprod Biol. 2001;  95 59-67
    CrossrefPubMedGoogle Scholar
  • 19 Audibert F, Benchimol Y, Benattar C, Champagne C, Frydman R. Prediction of preeclampsia or intrauterine growth restriction by second trimester serum screening and uterine Doppler velocimetry.  Fetal Diagn Ther. 2005;  20 48-53
    CrossrefPubMedGoogle Scholar
  • 20 Barkenhall-Thomas A, Wilson C, Baker L, ni Bhuinneain M, Wallace E M. Uterine artery Doppler velocimetry for the detection of adverse obstetric outcomes in patients with elevated mid-trimester beta-human chorionic gonadotropin.  Acta Obstet Gynecol Scand. 2005;  84 743-747
    CrossrefPubMedGoogle Scholar
  • 21 Tamura R K, Sabbagha R E. Percentile ranks of sonar fetal abdominal circumference measurements.  Am J Obstet Gynecol. 1980;  138 475-479
    PubMedGoogle Scholar
  • 22 Chauhan S P, Cole J, Sanderson M, Magann E F, Scardo J A. Suspicion of intrauterine growth restriction: use of abdominal circumference alone or estimated fetal weight below 10%.  J Matern Fetal Neonatal Med. 2006;  19 557-562
    CrossrefPubMedGoogle Scholar
  • 23 Baschat A A, Galan H L, Ross M G, Gabbe S G. Intrauterine growth restriction. In: Gabbe SG, Nieybl JR, Simpson JL Obstetrics Normal and Problem Pregnancies. 5th ed. Philadelphia; Churchill Livingstone 2007: 771-814
    PubMedGoogle Scholar
  • 24 Anderson N G, Jolley I J, Wells J E. Sonographic estimation of fetal weight: comparison of bias, precision, and consistency using 12 different formulae.  Ultrasound Obstet Gynecol. 2007;  30 173-179
    CrossrefPubMedGoogle Scholar

Tamera HatfieldM.D. Ph.D. 

101 City Drive South, Building 56

Suite 800, Orange, CA 92868. reprints not available from the author

Email: mfm@uci.edu

      >