Risk of neonatal care unit admission in small for gestational age fetuses at term: a prediction model and internal validation

Kalafat, Erkan
Morales-Rosello, Jose
Thilaganathan, Basky
Dhother, Jasreen
Khalil, Asma
Objective: Small for gestational age (SGA) fetuses are at increased risk of admission to the neonatal unit, even at term. We aimed to develop and validate a predictive model for the risk of prolonged neonatal unit admission in suspected SGA fetuses at term. Methods: A single-center cohort study of singleton pregnancies with SGA fetus, defined as estimated fetal weight (EFW) less than the 10th centile, at term. The variables included known risk factors for neonatal unit admissions: maternal characteristics, EFW, abdominal circumference (AC), fetal Dopplers, gestational age (GA) at delivery, and intrapartum risk factors (meconium, pyrexia). Logistic regression analysis was used for model building and the prediction models were validated internally using bootstrapping. Results: Seven hundred and one SGA pregnancies at term were included; 5.9% had prolonged neonatal unit admission (>48 h). The multivariable model (AUC 0.71; 95% CI: 0.63-0.79) included GA at delivery <39 weeks (OR 2.76; 95% CI 1.23-6.04, p = .011), cerebroplacental ratio (CPR) multiples of median (MoM) (OR 0.21; 95% CI 0.05-0.79, p = .023), and EFW below the third centile (OR 2.43; 95% CI 1.26-4.68, p < .007). The combined model showed a sensitivity 30.9% (95% CI: 16.6-45.2%) for a fixed 10% false positive rate. Conclusion: The prediction model shows good accuracy and good calibration for assessing the risk of neonatal unit admission in suspected SGA fetuses. It has the potential to be used for patient counseling, determining the timing of delivery and the individual risk.Brief rationale Objective: The objective of this study is to determine the factors associated with prolonged neonatal unit admissions in small for gestational age fetuses at term. What is already known: Fetal weight and Doppler parameters are associated with adverse outcome in small for gestational age fetuses. However, most studies use composite outcome criteria by combining neonatal unit admission with adverse delivery outcomes. A comprehensive model combining antenatal and intrapartum variables is also lacking. What this study adds: Our model describes the association of antenatal and intrapartum variables with prolonged neonatal unit admission without using a composite adverse outcome measure. Estimated fetal weight, gestational age at delivery, and the cerebroplacental ratio can be used to estimate the risk of prolonged neonatal unit admission. The risk estimation can be useful for patient counseling and to determine the time of delivery.


Efficacy of carbetocin in the prevention of postpartum hemorrhage: a systematic review and Bayesian meta-analysis of randomized trials
KALAFAT, ERKAN; Gokce, Ali; O'Brien, Pat; Benlioglu, Can; Koc, Acar; Karaaslan, Onur; Khalil, Asma (Informa UK Limited, 2019-09-19)
Objectives: To evaluate the efficacy of carbetocin for the prevention of postpartum hemorrhage (PPH) and related events after vaginal or cesarean delivery. Methods: Medline, Scopus, Embase, and the Cochrane Library were searched in February 2018 using combinations of the relevant MeSH terms, keywords. Randomized studies, comparing carbetocin to any other uterotonic agent, in the management of cesarean and vaginal deliveries, were conducted. Two reviewers independently extracted the data. A random-effects me...
Risk of operative delivery for intrapartum fetal compromise in small-for-gestational-age fetuses at term: an internally validated prediction model
Kalafat, Erkan; Morales-Rosello, Jose; Thilaganathan, Basky; Tahera, Fathema; Khalil, Asma (Elsevier BV, 2018-01-01)
BACKGROUND: Small-for-gestational-age fetuses are at an increased risk of intrapartum fetal compromise requiring operative delivery. Factors associated with the risk of intrapartum fetal compromise are yet to be established, and a comprehensive model accounting for both the antenatal and intrapartum variables is lacking.
Ultrasound in labor admission to predict need for emergency cesarean section: a prospective, blinded cohort study
Karaaslan, Onur; Islamova, Gunel; Soylemez, Feride; Kalafat, Erkan (Informa UK Limited, 2019-11-12)
Objective: To assess whether assessment with ultrasound could improve the detection of emergency cesarean section (ECS) in laboring women. Methods: Women who presented with symptoms of active labor or women in need of labor induction were invited to participate in the study. Women included in the study were evaluated with ultrasonography for fetal biometry and vaginal examinations for Bishop score assessment. The main aim in this study was determining factors associated with ECS due to fetal distress and ob...
Is umbilicocerebral ratio better than cerebroplacental ratio for predicting adverse pregnancy and neonatal outcomes?
Kalafat, Erkan; Kalaylioglu, Zeynep; Thilaganathan, Basky; Khalil, Asma (Elsevier BV, 2020-09-01)
Objective A secondary analysis of the trial of randomized umbilical and fetal flow in Europe suggested that the umbilicocerebral ratio (UCR) provides better differentiation of neurodevelopmental outcome in the abnormal range compared with that of the cerebroplacental ratio (CPR).1 However, the reported superiority of UCR is controversial.2 This study aimed to compare the CPR and the UCR for predicting operative delivery for presumed fetal compromise and prolonged neonatal unit (NNU) admission in term fetus...
Incidence of postpartum hypertension within 2 years of a pregnancy complicated by pre-eclampsia: a systematic review and meta-analysis
Giorgione, V; Ridder, A.; Kalafat, E.; Khalil, A.; Thilaganathan, B. (Wiley, 2020-10-01)
Background Women with a history of hypertensive disorders of pregnancy (HDP) are at increased long-term risk of cardiovascular disease. However, there has been increasing evidence on the same risks in the months following birth. Objectives This review aims to estimate the incidence of hypertension in the first 2 years after HDP. Search strategy MEDLINE, Embase and Cochrane databases were systematically searched in October 2019. Selection criteria Observational studies comparing hypertension rate following H...
Citation Formats
E. Kalafat, J. Morales-Rosello, B. Thilaganathan, J. Dhother, and A. Khalil, “Risk of neonatal care unit admission in small for gestational age fetuses at term: a prediction model and internal validation,” JOURNAL OF MATERNAL-FETAL & NEONATAL MEDICINE, pp. 2361–2368, 2019, Accessed: 00, 2020. [Online]. Available: https://hdl.handle.net/11511/67941.