Antenatal placental assessment in the prediction of adverse pregnancy outcome after reduced fetal movement

Abstract

Objective To assess the value of in utero placental assessment in predicting adverse pregnancy outcome after reported reduced fetal movements (RFM). Method A non-interventional prospective cohort study of women (N = 300) with subjective RFM at 28 weeks’ gestation in singleton non-anomalous pregnancies at a UK tertiary maternity hospital. Clinical, sonographic (fetal weight, placental size and maternal, fetal and placental arterial Doppler) and biochemical (maternal serum hCG, hPL, progesterone, PlGF and sFlt-1) assessment was conducted. Multiple logistic regression identified combinations of measurements (models) most predictive of adverse pregnancy outcome (perinatal mortality, birth weight <10 th centile, five minute Apgar score <7, umbilical arterial pH <7.1 or base excess <0.05). However, there was little improvement in other test characteristics (baseline vs. best proposed model: sensitivity 21.7% [95% confidence interval 13.1–33.6] vs. 35.8%% [24.4–49.3], specificity 96.6% [93.4–98.3] vs. 94.7% [90.7–97.0], PPV 61.9% [40.9–79.3] vs. 63.3% [45.5–78.1], NPV 82.8% [77.9–86.8] vs. 85.2% [80.0–89.2], positive LR 6.3 [2.8–14.6] vs. 6.7 [3.4–3.3], negative LR 0.81 [0.71–0.93] vs. 0.68 [0.55–0.83]) and wide confidence intervals. Negative post-test probability Remained high (16.7% vs. 14.0%). Conclusion Antenatal placental assessment may improve identification of RFM pregnancies at highest risk of adverse pregnancy outcome but further work is required to understand and refine currently available outcome definitions and diagnostic techniques to improve clinical utility.