Development and validation of a model for prediction of placental dysfunction-related stillbirth from maternal factors, fetal weight and uterine artery Doppler at mid-gestation.
Journal article
Ashoor, G, Syngelaki, A., Papastefanou, I., Nicolaides, K H and Akolekar, R. 2021. Development and validation of a model for prediction of placental dysfunction-related stillbirth from maternal factors, fetal weight and uterine artery Doppler at mid-gestation. Ultrasound in Obstetrics & Gynecology. https://doi.org/10.1002/uog.24795
| Authors | Ashoor, G, Syngelaki, A., Papastefanou, I., Nicolaides, K H and Akolekar, R. |
|---|---|
| Abstract | To examine the predictive performance for all antepartum stillbirths and those due to impaired placentation by a combination of maternal risk factors, uterine artery pulsatility index (UtA-PI) and estimated fetal weight (EFW) at 19-24 weeks' gestation in a training dataset for development of the model and a validation dataset. The data for this study were derived from prospective screening for adverse obstetric outcomes in 131,514 women with singleton pregnancies attending for routine pregnancy care at 19+0 to 24+6 weeks' gestation. There were 131,037 livebirths and 477 (0.36%) stillbirths, including 441 (92.5%) antepartum and 36 (7.5%) intrapartum stillbirths. Placental dysfunction related stillbirths accounted for 59.2% (261/441) of all antepartum stillbirths. The study population was divided into a training dataset used to develop prediction models for placental dysfunction related stillbirths which were then applied in the validation dataset. Multivariable logistic regression analysis was used to develop a model based on a combination of maternal risk factors, EFW Z-scores and UtA-PI multiple of the median (MoM). We examined the predictive performance of the model by first, the ability of the model to discriminate between the stillbirth and livebirth groups using the area under the receiver operating characteristic (AUROC) curve and the detection rate (DR) at fixed false positive rate (FPR) of 10%, and second, calibration by measurements of calibration slope and intercept. There are four main findings of this study. First, 92.5% of stillbirths were antepartum and 7.5% intrapartum and 59% of antepartum stillbirths were observed in association with placental dysfunction and 41% were unexplained or due to other causes. Second, placental dysfunction accounted for 80% of the stillbirths at <32 weeks' gestation, 54% at 32+0 to 36+6 weeks and 33% at ≥37 weeks. Third, the risk of placental dysfunction related stillbirth increased with increasing maternal weight and decreasing height, was 3-fold higher in black than in white women, 5.5-fold higher in parous women with previous stillbirth than livebirth, and was increased in smokers, in those with chronic hypertension, and in parous women with previous pregnancies complicated by preeclampsia and / or birth of small for gestational age babies. Fourth, in screening for placental dysfunction related stillbirth by a combination of maternal risk factors, EFW and UtA-PI, the DR at 10% FPR was 62.3% (57.2-67.4) and the AUROC curve was 0.838 (0.799-0.878); these results were consistent with those in the data used for developing the algorithm and demonstrate high discrimination between affected and unaffected pregnancies. Similarly, the calibration slope was 1.029 and intercept was -0.009 demonstrating a good agreement between the predicted risks and observed incidence of placental dysfunction related stillbirth. The performance of screening was better for stillbirths at <37 weeks' gestation compared to those at term (DR at 10% FPR 69.8% vs. 29.2%). Screening at mid-gestation by a combination of maternal risk factors, EFW and UtA-PI can predict a high proportion of placental dysfunction related stillbirths and in particular those that occur preterm. Such screening provides poor prediction of unexplained stillbirth or placental dysfunction related stillbirths at term. This article is protected by copyright. All rights reserved. [Abstract copyright: This article is protected by copyright. All rights reserved.] |
| Keywords | Uterine artery Doppler; Fetal biometry; Stillbirth; Pyramid of pregnancy care; Impaired placentation |
| Year | 2021 |
| Journal | Ultrasound in Obstetrics & Gynecology |
| Publisher | Wiley |
| ISSN | 1469-0705 |
| Digital Object Identifier (DOI) | https://doi.org/10.1002/uog.24795 |
| Official URL | https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/uog.24795 |
| Publication dates | |
| Online | 13 Oct 2021 |
| Publication process dates | |
| Accepted | 04 Oct 2021 |
| Deposited | 25 Sep 2024 |
| Output status | Published |
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https://repository.canterbury.ac.uk/item/960x3/development-and-validation-of-a-model-for-prediction-of-placental-dysfunction-related-stillbirth-from-maternal-factors-fetal-weight-and-uterine-artery-doppler-at-mid-gestation
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