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Predictive performance for placental dysfunction related stillbirth of the competing risks model for small for gestational age fetuses
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  • Kypros Nicolaides,
  • Ioannis Papastefanou,
  • Argyro Syngelaki,
  • Ghalia Ashoor,
  • Ranjit Akolekar
Kypros Nicolaides
Fetal Medicine Institute
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Ioannis Papastefanou
Fetal Medicine Clinic, Monis Petraki 4, Kolonaki, 11521, Athens, Greece
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Argyro Syngelaki
King's College Hospital
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Ghalia Ashoor
Fetal Medicine Research Institute
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Ranjit Akolekar
Medway Maritime Hospital
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Abstract

Objectives: First, to examine the predictive performance for placental dysfunction related stillbirths of the competing risks model for small for gestational age (SGA) fetuses based on a combination of maternal risk factors, estimated fetal weight (EFW) and uterine artery pulsatility index (UtA-PI); and second, to compare the performance of this model to that of stillbirth-specific model utilizing the same biomarkers and to the Royal College of Obstetricians and Gynecologists (RCOG) guideline for the investigation and management of the SGA fetus. Design: Prospective observational study. Setting: Two UK maternity hospitals. Population: 131,514 women with singleton pregnancies attending for routine ultrasound examination at 19-24 weeks’ gestation. Methods: The predictive performance for stillbirth achieved by three models was compared. Main outcome measures: Placental dysfunction related stillbirth. Results: At 10% false positive rate, the competing risks model predicted 59%, 66% and 71% of placental dysfunction related stillbirths, at any gestation, at <37 weeks and at <32 weeks, respectively, which were similar to the respective figures of 62%, 70% and 73% for the stillbirth-specific model. At a screen positive rate of 21.8 %, as defined by the RCOG guideline, the new model predicted 71%, 76% and 79% of placental dysfunction related stillbirths at any gestation, at <37 weeks and at <32 weeks, respectively, and the respective figures for the RCOG guideline were 42%, 44% and 40%. Conclusion: The predictive performance for placental dysfunction related stillbirths by the competing risks model for SGA was similar to the stillbirth-specific model and superior to the RCOG guideline.
25 Oct 2021Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
26 Oct 2021Submission Checks Completed
26 Oct 2021Assigned to Editor
27 Oct 2021Reviewer(s) Assigned
10 Nov 2021Review(s) Completed, Editorial Evaluation Pending
18 Nov 2021Editorial Decision: Revise Major
26 Nov 20211st Revision Received
27 Nov 2021Review(s) Completed, Editorial Evaluation Pending
27 Nov 2021Submission Checks Completed
27 Nov 2021Assigned to Editor
14 Dec 2021Editorial Decision: Accept
06 Jan 2022Published in BJOG: An International Journal of Obstetrics & Gynaecology. 10.1111/1471-0528.17066