Brauchen wir ein Ultraschallscreening im späten dritten Trimenon zur besseren Detektion wachstumsrestringierter Feten?

The rates of stillbirths and other adverse perinatal outcomes are inversely correlated with the percentile of the birth weight. In general, fetuses with a sonographically determined estimated weight below the 10th percentile of ultrasound-based standard growth charts, so-called small for gestational age (SGA) fetuses, are subjected to intensified monitoring, as are pregnancies with pre-existing risk factors or corresponding abnormal findings during prenatal care. This approach does not currently include low-risk pregnancies, especially nulliparous pregnancies in which the risk of placenta-relatzed complications is also increased. As in the majority of cases of fetal growth restriction (FGR) the growth late only starts to be restricted in the third trimester, the current German ultrasound screening at 28 + 0–31 + 6 weeks gestation is too early to detect the vast majority of SGA and FGR neonates. In this respect, it is evident that further screening at 35 + 0–36 + 6 weeks gestation would be necessary to increase the detection rate for SGA and FGR. The advantages and disadvantages of ultrasound screening are shown in this context and alternative models for detection and prediction of SGA, FGR and adverse perinatal outcomes are discussed.