Background and Objectives: To evaluate weight-indexed umbilical systolic diastolic ratio (UASDR) to discriminate risk for adverse outcomes among growth restricted fetuses (FGR).
Design and Setting: Retrospective study using prenatal ultrasound data and neonatal outcome data. Two primary outcomes: admission to intensive care and a composite outcome of severe neonatal morbidity. We included births among individuals with a singleton pregnancy at 24–40 weeks gestation without other indications for preterm delivery. We calculated the percentile of the measured standard UASDR, and the same value indexed to the EFW (iUASDR).
Results: 296 pregnancies met inclusion criteria. Forty-seven percent required NICU admission and 31% developed a component of the composite outcome. The sensitivity of the iUASDR increased at lower birthweight percentiles. The positive predictive value of the standard UASDR was higher among fetuses with EFW <5th % and <10th % for NICU admission and composite outcome ((EFW <5th %) 0.82 (95% CI: 0.71, 0.91) and 0.60 (95% CI: 0.48, 0.72) and ((EFW <10th %) 0.81 (95% CI: 0.70, 0.89) and 0.58 (95% CI: 0.45, 0.69) compared with indexed values.
Discussion: Data does not support use of the iUASDR to improve the test characteristics of the UASDR. Despite a moderate increase in specificity, the positive predictive value was low. UASDR non-indexed or standard values in conjunction with clinical findings and severity of FGR perform best.
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