Clinical implications of the study
A high proportion of placental dysfunction related stillbirths can
potentially be prevented by a three stage strategy. First, screening for
preeclampsia at 11-13 weeks’ gestation and treatment of the high-risk
group by aspirin; this is effective in the prevention of preterm
preeclampsia but also in the prevention of early SGA in the absence of
preeclampsia 25-30. Second, screening during the
routine mid-trimester scan by a combination of maternal risk factors,
EFW and UtA-PI, which identifies a high-risk group that contains a high
proportion of placental dysfunction related stillbirths that occur at
24-37 weeks’ gestation; close monitoring of these pregnancies for early
diagnosis of SGA fetuses could prevent at least some of such stillbirths
by defining the best approach to monitoring and best timing of delivery.
The detection rate of stillbirths is higher when UtA-PI is included in
the model in addition to maternal risk factors and EFW, highlighting the
necessity of including this measurement in the routine mid-trimester
scan; it is easy for competent sonographers to learn this technique and
it only adds about 2 minutes to the examination. Third, routine
ultrasound examination at 36 weeks’ gestation, because screening at
mid-gestation provides poor prediction of stillbirth at term; more
effective screening for late SGA can be achieved by screening at 3631,32.