Restricción de crecimiento intrauterino según curvas personalizadas peruanas: estudio de validación y precisión diagnóstica

Oswaldo  Tipiani-Rodríguez; Yuliana Libet  Bocanegra-Becerra; Cristopher  Huarag-Chavarry; Kristtel  Figueroa-Morales; Miguel Ángel  Ponciano- Biaggi

doi:10.31403/rpgo.v70i2593

Authors

Oswaldo Tipiani-Rodríguez Departamento de Gineco Obstetricia, Hospital Nacional Alberto Sabogal Sologuren, EsSalud
Yuliana Libet Bocanegra-Becerra Departamento de Gineco Obstetricia, Hospital Nacional Alberto Sabogal Sologuren, EsSalud
Cristopher Huarag-Chavarry Departamento de Gineco Obstetricia, Hospital Nacional Alberto Sabogal Sologuren, EsSalud
Kristtel Figueroa-Morales Departamento de Gineco Obstetricia, Hospital Nacional Alberto Sabogal Sologuren, EsSalud
Miguel Ángel Ponciano- Biaggi Departamento de Gineco Obstetricia, Hospital Nacional Alberto Sabogal Sologuren, EsSalud

DOI:

https://doi.org/10.31403/rpgo.v70i2593

Keywords:

Perinatal care, Fetal growth retardation, Fetal development, Ultrasonography, prenatal, Fetal research, Perinatal mortality

Abstract

Introduction: There is no consensus on the growth curve to be used to assess fetal
growth. Objectives: To validate customized curves and study their performance
in the detection of neonates with intrauterine growth restriction (IUGR), as well
as their diagnostic accuracy. Methods: Initially, customized curves were designed
with 2,792 singleton fetuses from low-risk pregnancies; the optimal weight at 40
weeks = 1,496.202 + (64.379 x fetal sex) + (831.362 x maternal length) + (9.567 x
pregestational weight) was calculated and combined with a standard proportionality
function to adjust the weights according to gestational age. Subsequently, its
performance was evaluated by applying it in a retrospective cohort of neonates aged
24–40 weeks born between 2018-2022 in a tertiary hospital in Lima-Peru. Twins and
congenital anomalies were excluded. Results: A total of 6,598 neonates were studied.
Customized curves showed good agreement with INTERGROWTH-21 (IG21) (kappa
= 0.68; 95%CI = 0.62-0.74). They detected 2.8% of IUGR (184/6,598), similar to the
3.1% for IG21 (205/6,598). They showed high specificity and negative positive value
(NPV) (97% and 98%; 95%CI = 97-98% and 98-99%, respectively). The risk for perinatal
death (RR = 7.2; 95%CI = 4.6-11) and accuracy (96; 95%CI = 95-96%) were higher than
those of the Fetal Medicine Foundation (FMF) (RR=3.6; 95%CI = 2.5-5.2 and accuracy=
89%; 95%CI = 88-89%, respectively). Conclusion: The customized Peruvian curves
were reliable in assessing IUGR. Their detection capacity and diagnostic accuracy
were similar to other international curves, although somewhat higher than those of
the FMF.