Identification of the optimal growth chart and threshold for the prediction of antepartum stillbirth

Liran Hiersch*, Hayley Lipworth, John‏ Kingdom, Jon Barrett, Nir Melamed

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Purpose: To evaluate the effect of the choice growth chart and threshold used to define small for gestational age (SGA) on the predictive value of SGA for placenta-related or unexplained antepartum stillbirth. Methods: A retrospective cohort study of all women with a singleton pregnancy who gave birth > 24 week gestation in a single center (2000–2016). The exposure of interest was SGA, defined as birth weight < 10th or < 25th centile according to three fetal growth charts (Hadlock et al., Radiology 181:129–133, 1991; intergrowth-21st (IG21), WHO 2017, and a Canadian birthweight-based reference—Kramer et al., Pediatrics 108:E35, 2001). The outcome of interest was antepartum stillbirth due to placental dysfunction or unknown etiology. Cases of stillbirth attributed to other specific etiologies were excluded. Results: A total of 49,458 women were included in the cohort. There were 103 (0.21%) cases of stillbirth due to placental dysfunction or unknown etiology. For cases in the early stillbirth cluster (≤ 30 weeks), the detection rate was high and was similar for the three ultrasound-based fetal growth charts of Hadlock, IG21, and WHO (range 83.3–87.0%). In contrast, the detection rate of SGA for cases in the late stillbirth cluster (> 30 weeks) was low, being highest for WHO and Hadlock (36.7% and 34.7%, respectively), and lowest for IG21 (18.4%). Using a threshold of the 25th centile increased the detection rate for stillbirth by approximately 15–20% compared with that achieved by the 10th centile cutoff. Conclusion: At > 30 week gestation, the Hadlock or WHO fetal growth charts provided the best balance between detection rate and false positive rate for stillbirth.

Original languageEnglish
Pages (from-to)381-390
Number of pages10
JournalArchives of Gynecology and Obstetrics
Issue number2
StatePublished - Feb 2021


  • Detection
  • Growth charts
  • Prediction
  • Small for gestational age
  • Stillbirth


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