Externally validated nomogram for predicting short-term pregnancy outcome of singleton pregnancies with fetal growth restriction (FGR)

Objective This study aimed at developing an available predictive model of singleton pregnancies with fetal growth restriction (FGR) for accurate and individualised prognosis assessment.Methods The prediction nomogram was developed by using multivariable Cox regression with data for 301 singleton FGR...

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Main Authors: Yang Li, Xiaohong Zhang, Junshu Xie, Fufen Yin, Mingrui Jin, Yujing Li, Xiuju Yin
Format: Article
Language:English
Published: BMJ Publishing Group 2024-04-01
Series:Gynecology and Obstetrics Clinical Medicine
Online Access:https://gocm.bmj.com/content/4/1/e000009.full
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author Yang Li
Xiaohong Zhang
Junshu Xie
Fufen Yin
Mingrui Jin
Yujing Li
Xiuju Yin
author_facet Yang Li
Xiaohong Zhang
Junshu Xie
Fufen Yin
Mingrui Jin
Yujing Li
Xiuju Yin
author_sort Yang Li
collection DOAJ
description Objective This study aimed at developing an available predictive model of singleton pregnancies with fetal growth restriction (FGR) for accurate and individualised prognosis assessment.Methods The prediction nomogram was developed by using multivariable Cox regression with data for 301 singleton FGR pregnancies at Peking University People’s Hospital. External validation was performed in 321 eligible singleton FGR pregnancies at the Affiliated Hospital of Qingdao University.Results Absent umbilical arterial flow, fetal anomaly, history of abnormal pregnancy, non-cephalic presentation and history of caesarean section were independent prognostic factors for adverse perinatal outcomes in singleton FGR pregnancies in the training set. In the training cohort of the internal validation set, the nomogram estimated pregnancy prognosis of FGR singleton pregnancies based on these five variables, with a concordance index (C-index) of 0.859 (95% CI: 0.81 to 0.90) for predicting termination of pregnancy (TOP), which included intrauterine fetal death and therapeutic lethal induction, with a C-index of 0.92 (95% CI: 0.86 to 0.98) for predicting stillbirth, and a C-index of 0.87 (95% CI: 0.83 to 0.92) for predicting therapeutic lethal induction with indications. Encouragingly, consistent results were observed in the external validation set, with a C-index of 0.776 (95% CI: 0.71 to 0.84) for predicting TOP, which included intrauterine fetal death and therapeutic lethal induction, with a C-index of 0.773 (95% CI: 0.70 to 0.84) for predicting stillbirth, and a C-index of 0.776 (95% CI: 0.70 to 0.85) for predicting therapeutic lethal induction with indications. Furthermore, the calibrations of the nomograms predicting the 28th and 34th TOP-free gestation week strongly corresponded to the actual survival outcome.Conclusion This prediction model may help clinicians in decision-making for singleton pregnancies with FGR, especially for patients with a single abnormal umbilical arterial flow or fetal anomaly, without induced labour indications for these abnormalities.
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spelling doaj-art-83676d11ace24b5eb8204ac7c3868ca42025-01-19T06:05:09ZengBMJ Publishing GroupGynecology and Obstetrics Clinical Medicine2097-05872667-16462024-04-014110.1136/gocm-2024-000009Externally validated nomogram for predicting short-term pregnancy outcome of singleton pregnancies with fetal growth restriction (FGR)Yang Li0Xiaohong Zhang1Junshu Xie2Fufen Yin3Mingrui Jin4Yujing Li5Xiuju Yin6Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, ChinaDepartment of Hematology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China1 Department of Obstetrics and Gynecology, Peking University People`s Hospital, Beijing, China1 Department of Obstetrics and Gynecology, Peking University People`s Hospital, Beijing, China2 Department of Ophthalmology, Beijing Tongren Eye Center, Capital Medical University, Beijing, China3 Department of Pathology, China Medical University College of Basic Medical Sciences, Shenyang, Liaoning, China1 Department of Obstetrics and Gynecology, Peking University People`s Hospital, Beijing, ChinaObjective This study aimed at developing an available predictive model of singleton pregnancies with fetal growth restriction (FGR) for accurate and individualised prognosis assessment.Methods The prediction nomogram was developed by using multivariable Cox regression with data for 301 singleton FGR pregnancies at Peking University People’s Hospital. External validation was performed in 321 eligible singleton FGR pregnancies at the Affiliated Hospital of Qingdao University.Results Absent umbilical arterial flow, fetal anomaly, history of abnormal pregnancy, non-cephalic presentation and history of caesarean section were independent prognostic factors for adverse perinatal outcomes in singleton FGR pregnancies in the training set. In the training cohort of the internal validation set, the nomogram estimated pregnancy prognosis of FGR singleton pregnancies based on these five variables, with a concordance index (C-index) of 0.859 (95% CI: 0.81 to 0.90) for predicting termination of pregnancy (TOP), which included intrauterine fetal death and therapeutic lethal induction, with a C-index of 0.92 (95% CI: 0.86 to 0.98) for predicting stillbirth, and a C-index of 0.87 (95% CI: 0.83 to 0.92) for predicting therapeutic lethal induction with indications. Encouragingly, consistent results were observed in the external validation set, with a C-index of 0.776 (95% CI: 0.71 to 0.84) for predicting TOP, which included intrauterine fetal death and therapeutic lethal induction, with a C-index of 0.773 (95% CI: 0.70 to 0.84) for predicting stillbirth, and a C-index of 0.776 (95% CI: 0.70 to 0.85) for predicting therapeutic lethal induction with indications. Furthermore, the calibrations of the nomograms predicting the 28th and 34th TOP-free gestation week strongly corresponded to the actual survival outcome.Conclusion This prediction model may help clinicians in decision-making for singleton pregnancies with FGR, especially for patients with a single abnormal umbilical arterial flow or fetal anomaly, without induced labour indications for these abnormalities.https://gocm.bmj.com/content/4/1/e000009.full
spellingShingle Yang Li
Xiaohong Zhang
Junshu Xie
Fufen Yin
Mingrui Jin
Yujing Li
Xiuju Yin
Externally validated nomogram for predicting short-term pregnancy outcome of singleton pregnancies with fetal growth restriction (FGR)
Gynecology and Obstetrics Clinical Medicine
title Externally validated nomogram for predicting short-term pregnancy outcome of singleton pregnancies with fetal growth restriction (FGR)
title_full Externally validated nomogram for predicting short-term pregnancy outcome of singleton pregnancies with fetal growth restriction (FGR)
title_fullStr Externally validated nomogram for predicting short-term pregnancy outcome of singleton pregnancies with fetal growth restriction (FGR)
title_full_unstemmed Externally validated nomogram for predicting short-term pregnancy outcome of singleton pregnancies with fetal growth restriction (FGR)
title_short Externally validated nomogram for predicting short-term pregnancy outcome of singleton pregnancies with fetal growth restriction (FGR)
title_sort externally validated nomogram for predicting short term pregnancy outcome of singleton pregnancies with fetal growth restriction fgr
url https://gocm.bmj.com/content/4/1/e000009.full
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