Added Value of Estimated Fetal Weight Growth Velocity to Doppler Evaluation for the Prediction of Perinatal Outcomes Among Foetuses With EFW < 10th Centile at Term: A Retrospective Cohort Study

OBJECTIVE: To evaluate whether estimated fetal weight (EFW) growth velocity (GV), assessed using interval-specific standards, provides additional prediction beyond standard criteria for identifying adverse outcomes in term foetuses with EFW < 10th centile. DESIGN: Retrospective cohort study. SETTING: Tertiary perinatal centre. POPULATION: A cohort of 600 singleton pregnancies diagnosed with EFW < 10th above 32 weeks and term delivered. METHODS: GV between the diagnosis of SGA (EFW < 10th centile) and the last ultrasound before delivery was defined according to interval-specific standards in cases with at least two scans ≥ 14 days apart. Slow GV was considered the threshold for a 10% false positive rate for detecting SGA at birth according to published references [Hugh O. 2022]. Fetal growth restriction (FGR) was defined if: EFW < 3rd centile, middle cerebral artery pulsatility index or cerebroplacental ratio (CPR) < 5th centile, or umbilical or uterine artery pulsatility index (UtA-PI) ≥ 95th centile. Slow GV was defined below the 10th centile adjusted for gestational age. Logistic regression analysis was performed. MAIN OUTCOME MEASURES: A composite adverse outcome (CAO) comprising neonatal morbidity or preeclampsia. RESULTS: Slow GV was observed in 31.8% of cases. No significant differences were observed between groups in maternal characteristics, gestational age at diagnosis. At the last scan, foetuses with slow GV more frequently had an EFW < 3rd centile (52.4% vs. 23.2%; p < 0.001) and BW < 3rd centile (51.6% vs. 62.8; p < 0.05) and abnormal umbilical artery Doppler (4.2% vs. 1.0%; p = 0.023). No differences were observed in CAO rates (22.7% vs. 26.6%; p = 0.689). In multivariable analysis, EFW < 3rd centile, abnormal UtA-PI, and low CPR were independent predictors of CAO. Adding slow GV did not improve predictive performance (AUC 0.64 vs. 0.64; p = 0.54). CONCLUSIONS: In term foetuses with EFW < 10th centile, slow EFW GV does not enhance the prediction of adverse perinatal outcomes beyond established Doppler and biometric criteria, questioning its clinical utility.