scholarly journals Risk of adverse outcomes for small fetuses not meeting consensus criteria for fetal growth restriction

2022 ◽  
Vol 226 (1) ◽  
pp. S504-S505
Author(s):  
Jennifer E. Powel ◽  
Emily W. Zantow ◽  
Matthew F. Bialko ◽  
Lauren G. Farley ◽  
Tracy M. Tomlinson
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Adverse Outcomes ◽  
Growth Restriction

scholarly journals Metabolomics for predicting fetal growth restriction: protocol for a systematic review and meta-analysis

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e022743 ◽  
Author(s):  
Debora Farias Batista Leite ◽  
Aude-Claire Morillon ◽  
Elias F Melo Júnior ◽  
Renato T Souza ◽  
Ali S Khashan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Diagnostic Accuracy ◽  
Fetal Growth ◽  
Gestational Age ◽  
Fetal Growth Restriction ◽  
Case Reports ◽  
Meta Analysis ◽  
Adverse Outcomes ◽  
Growth Restriction ◽  
Sample Collection

IntroductionFetal growth restriction (FGR) is a relevant research and clinical concern since it is related to higher risks of adverse outcomes at any period of life. Current predictive tools in pregnancy (clinical factors, ultrasound scan, placenta-related biomarkers) fail to identify the true growth-restricted fetus. However, technologies based on metabolomics have generated interesting findings and seem promising. In this systematic review, we will address diagnostic accuracy of metabolomics analyses in predicting FGR.Methods and analysisOur primary outcome is small for gestational age infant, as a surrogate for FGR, defined as birth weight below the 10th centile by customised or population-based curves for gestational age. A detailed systematic literature search will be carried in electronic databases and conference abstracts, using the keywords ‘fetal growth retardation’, ‘metabolomics’, ‘pregnancy’ and ‘screening’ (and their variations). We will include original peer-reviewed articles published from 1998 to 2018, involving pregnancies of fetuses without congenital malformations; sample collection must have been performed before clinical recognition of growth impairment. If additional information is required, authors will be contacted. Reviews, case reports, cross-sectional studies, non-human research and commentaries papers will be excluded. Sample characteristics and the diagnostic accuracy data will be retrieved and analysed. If data allows, we will perform a meta-analysis.Ethics and disseminationAs this is a systematic review, no ethical approval is necessary. This protocol will be publicised in our institutional websites and results will be submitted for publication in a peer-reviewed journal.PROSPERO registration numberCRD42018089985.

P1040PREGNANCY IN WOMEN WITH DIABETIC NEPHROPATHY: COMPLICATIONS AND OUTCOMES

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Elena Prokopenko ◽  
Andrey Vatazin ◽  
Vera Gurieva ◽  
Irina Nikol`skaya ◽  
Fatima Burumkulova ◽  
...  
Keyword(s):  
Diabetic Nephropathy ◽  
Cesarean Section ◽  
Preterm Delivery ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Adverse Outcomes ◽  
Growth Restriction ◽  
Fetal Macrosomia ◽  
Ckd Stage

Abstract Background and Aims Pregnancy in patients with diabetic nephropathy (DN) is characterized by an increased incidence of complications and adverse outcomes. The aim of the study was to determine the nature and incidence of pregnancy complications and maternal and fetal outcomes in women with DN. Method 61 pregnant women with diabetes mellitus (DM) type 1 and CKD 1-4 stages: 1 st. –29 patients, 2 st. - 19, 3-4 st. – 13 (age 29.7±4.9 years, DM duration 18.6 ± 5,3 years) and 72 pregnant patients with pre-existing (type 1) DM without CKD (age 28.2±4.8 years, DM duration 11.4 ±3.7 years) observed in 2010-2017 were included. The incidence of chronic arterial hypertension (AH), preeclampsia (PE), fetal macrosomia, fetal growth restriction, preterm delivery, cesarean section, stillbirth and the effect of pregnancy on kidney function were evaluated. Results Chronic AH was detected in 19.4% of women w/o CKD, in 10.3% – CKD 1 st, 17.6% – CKD2, 61.3% – CKD 3-4 (p &lt 0.05 CKD3-4 vs CKD1). The incidence of PE in patients w/o CKD was 12.5% (2-3% for general population), with CKD 1 – 24.1%, CKD 2 – 41.2%, CKD 3-4 – 38.5% (p &lt 0.001 when comparing all groups). Macrosomia was common in pregnant diabetic women w/o CKD (30.6%), patients with CKD 1 (41.4%) and CKD 2 (52.9%), but was not observed in CKD 3-4 (0%). In contrast, the incidence of fetal growth restriction was highest with CKD 3-4 (61.5%) compared women w/o CKD (5.6%) and with CKD1(13.8%) and CKD2 (11.8%), p &lt 0.05.Preterm delivery was more common in women with CKD, and its frequency increased with increasing severity of CKD: w/o CKD – 18.1%, CKD 1 – 48.3%, CKD2 – 61.3%, CKD 3-4 –84.6% (p &lt 0.05). Incidence of cesarean section was high and did not differ significantly between groups: w/o CKD – 62.5.1%, CKD 1 – 55.2%, CKD2 – 82.4%, CKD 3-4 –92.3% (p &gt 0.05). Stillbirth was observed only with CKD stage 3-4 in 15.4% of cases.Four out of 13 (30.8%) patients with pre-existing CKD 3-4 and none of the patients with CKD1-2 reached stage 5 CKD and started regular hemodialysis with a median follow-up period of 43.3 months (min 29.7 - max. 81.5). Conclusion DN has a negative effect on pregnancy outcomes, increasing the frequency of preeclampsia, fetal growth restriction, preterm birth and stillbirth, however, fetal macrosomia practically does not occur with CKD 3-4. The rapid achievement of CKD 5D after delivery is typical for diabetic women with advanced stages of CKD.

Fetal growth restriction and perinatal adverse outcomes associated with extremely high values of the sFlt-1/PlGF ratio

2019 ◽  
Vol 17 ◽  
pp. S28-S29
Author(s):  
C. Villalaín ◽  
L. Valle ◽  
M. Mendoza ◽  
M. Vázquez-Fernández ◽  
A. Fernández Oliva ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Adverse Outcomes ◽  
Growth Restriction ◽  
Plgf Ratio

Obstetric and pediatric growth charts for the detection of late-onset fetal growth restriction and neonatal adverse outcomes

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Beatriz Fernandez-Rodriguez ◽  
Concepción de Alba ◽  
Alberto Galindo ◽  
David Recio ◽  
Cecilia Villalain ◽  
...  
Keyword(s):  
Prenatal Diagnosis ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Late Onset ◽  
Perinatal Outcomes ◽  
Adverse Outcomes ◽  
Growth Restriction ◽  
Growth Standards ◽  
Postnatal Diagnosis ◽  
Increased Risk

AbstractObjectivesLate-onset fetal growth restriction (FGR) has heterogeneous prenatal and postnatal diagnostic criteria. We compared the prenatal and postnatal diagnosis of late-onset FGR and their ability to predict adverse perinatal outcomes.MethodsRetrospective cohort study of 5442 consecutive singleton pregnancies that delivered beyond 34 + 0 weeks. Prenatal diagnosis of FGR was based on customized fetal growth standards and fetal Doppler while postnatal diagnosis was based on a birthweight <3rd percentile according to newborn charts (Olsen’s charts and Intergrowth 21st century programme). Perinatal outcomes were analyzed depending on whether the diagnosis was prenatal, postnatal or both.ResultsA total of 94 out of 5442 (1.7%) were diagnosed as late-onset FGR prenatally. Olsen’s chart and Intergrowth 21st chart detected that 125/5442 (2.3%) and 106/5442 (2.0%) of infants had a birthweight <3rd percentile, respectively. These charts identified 35/94 (37.2%) and 40/94 (42.6%) of the newborns with a prenatal diagnosis of late-onset FGR. Prenatally diagnosed late-onset FGR infants were at a higher risk for hypoglycemia, jaundice and polycythemia. Both prenatally and postnatally diagnosed as late-onset FGR had a higher risk for respiratory distress syndrome when compared to non-FGR. The higher risks for intensive care admission and composite adverse outcomes were observed in those with a prenatal diagnosis of late-onset FGR that was confirmed after birth.ConclusionsCurrent definitions of pre- and postnatal late-onset FGR do not match in more than half of cases. Infants with a prenatal or postnatal diagnosis of this condition have an increased risk of neonatal morbidity even if these diagnoses are not coincident.

scholarly journals 157: Midtrimester fetal growth restriction: is small abdominal circumference associated with adverse outcomes?

2017 ◽  
Vol 216 (1) ◽  
pp. S105-S106
Author(s):  
Lorene A. Temming ◽  
Fayola F. Fears ◽  
Omar M. Young ◽  
Molly J. Stout ◽  
Methodius G. Tuuli ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Adverse Outcomes ◽  
Growth Restriction ◽  
Abdominal Circumference

scholarly journals Pregnancy associated plasma protein A: an early predictor of fetal growth restriction

2021 ◽  
Vol 10 (12) ◽  
pp. 4517
Author(s):  
Pavan Bhargava Chandramohan ◽  
Sarita Agrawal ◽  
Chandrashekhar Shrivastava ◽  
Sarita Rajbhar ◽  
Prasanta Nayak ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Plasma Protein ◽  
Predictive Value ◽  
Fetal Growth Restriction ◽  
Protein A ◽  
Outcome Data ◽  
Adverse Outcomes ◽  
Growth Restriction ◽  
Low Levels ◽  
Sensitivity Specificity

Background: The aim of our study was to determine the association of low levels of pregnancy associated plasma protein-A (PAPP-A) levels estimated at 11-13+6weeks of gestation with fetal growth restriction (FGR).Methods: A prospective observational study of a total of 203 pregnant women with PAPP-A levels were followed up and the outcome data were collected at childbirth.Results: The incidence of FGR was 7.3%. A significant association was found between low levels of PAPP-A MoM (≤0.49) with FGR (p=0.000) with unadjusted odds ratio of 11.6. At PAPP-A multiples of median (MoM) ≤0.49, FGR had a median (Q1, Q3) of 0.46 (0.42, 1.54) versus 1.87 (0.59, 3.11) which was statistically significant (p=0.05) with moderate strength of prediction [minus 0.58 (95% CI, minus 1.113, minus 0.055), p=0.03]. At the cut-off considered in our study i.e., ≤0.49 MoM, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 73%, 81%, 23%, and 97% respectively with a positive LR of 3.82 and negative LR of 0.32. Karl Pearson’s correlation showed positive correlation (r=0.308, p<0.001) between PAPP-A MoM and birthweight and showed that for every unit increase in PAPP-A MoM, birthweight increased by 0.082 times (approximately 90 gm). We also found an association of low PAPP-A with pre-eclampsia, preterm delivery and increased caesarean delivery births.Conclusions: We conclude that low PAPP-A MoM levels are good reflectors of placental function and adverse outcomes. PAPP-A, a part of the dual marker, may be extrapolated for suspecting FGR. This could guide in instituting appropriate feto-maternal surveillance.

scholarly journals Sildenafil citrate and uteroplacental perfusion in fetal growth restriction

2018 ◽  
Vol 7 (12) ◽  
pp. 5116
Author(s):  
Priya Singh ◽  
Hena Saiyda
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Perinatal Outcomes ◽  
Adverse Outcomes ◽  
Growth Restriction ◽  
Sildenafil Citrate ◽  
Control Group ◽  
Placental Perfusion ◽  
Phosphodiesterase Type 5 Inhibitor ◽  
The Difference

Background: Severe early-onset fetal growth restriction can lead to a range of adverse outcomes including fetal or neonatal death, neurodisability, and lifelong risks to the health of the affected child. Sildenafil, a phosphodiesterase type 5 inhibitor, potentiates the actions of nitric oxide, which leads to vasodilatation of the uterine vessels and might improve fetal growth in utero. The objective is to evaluate effectiveness and safety of Sildenafil citrate for treatment of Doppler velocimetry of uterine, umbilical artery for systolic/diastolic ratio (S/D ratio) at first visit, after 2 hours and then after 12 weeks of treatment.Methods: A case control study was carried out in 96 antenatal women with fetal growth restriction over a period of twelve months. A written informed consent was obtained. Out of 96, 12 were lost to follow up. Of remaining 84 women, 42 were included in the study group and 42 in the control group. First group (case) received Sildenafil citrate 50 mg stat followed by colour Doppler after 2 hours and then 25 mg three times a day for 12 weeks. The second group (control) received placebo in for 12 weeks.Results: Sildenafil treatment was associated with a significant increase in length of pregnancy (P> 0.05) overall mean S/D ratio pre-sildenafil was 5.34±0.93 which reduced to 5.18 ± 0.95 after 2 hours of sildenafil administration and this significant was highly significant (p<0.0001).and also the mean S/D ratio pre-treatment was 6.72±0.38 which decreased to 3.52±0.47 after 12 weeks of sildenafil administration. The difference between them was found to be extremely significant (p<0.0001).Conclusions: Sildenafil citrate can improve utero-placental perfusion and length of pregnancy in pregnancies complicated by IUGR. It appears to have a significantly positive effect on fetal weight. Sildenafil treatment may offer a new opportunity to improve perinatal outcomes, for pregnancies complicated by IUGR. However, these observations require further studies on wide scale.

Soluble Endoglin and Uterine Artery Flow Doppler Ultrasonography as Markers of Progression to Preeclampsia in Women with Gestational Hypertension

2021 ◽  
pp. 1-9
Author(s):  
Carlos José Molina Pérez ◽  
Ana Graciela Nolasco Leaños ◽  
Reyes Ismael Carrillo Juárez ◽  
María Guadalupe Berumen Lechuga ◽  
Irma Isordia Salas ◽  
...  
Keyword(s):  
Preterm Delivery ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Doppler Ultrasonography ◽  
Gestational Hypertension ◽  
Adverse Outcomes ◽  
Growth Restriction ◽  
Soluble Endoglin ◽  
Risk Of Progression ◽  
Artery Flow

<b><i>Introduction:</i></b> Gestational hypertension (GH) pregnancies are at a high risk of developing adverse outcomes, including progression to preeclampsia. Prediction of GH-related adverse outcomes is challenging because there are no available clinical tests that may predict their occurrence. <b><i>Objective:</i></b> The aim of the study was to determine the clinical usefulness of the soluble endoglin (sEng) and parameters of uterine artery flow (UtAF) measured by Doppler ultrasonography as markers of progression to preeclampsia in women with GH. <b><i>Setting:</i></b> Mexico City, Mexico. <b><i>Material and Methods:</i></b> We included 77 singleton pregnant women with GH in a nested case-control study. Cases were women who progressed to preeclampsia (<i>n</i> = 36), and controls were those who did not <b>(</b><i>n</i> = 41). Serum sEng and UtAF measurements were performed at enrollment. The main outcomes measured were progression to preeclampsia and occurrence of preterm delivery (PD) &#x3c;37 and &#x3c;34 weeks of gestation, small for gestational age infant (SGA), and fetal growth restriction (FGR). <b><i>Results:</i></b> Women with sEng values in the highest tertile had higher risk of progression to preeclampsia, preterm delivery &#x3c;34 weeks of gestation, and fetal growth restriction, odds ratios (ORs) ≥3.7. Patients with abnormal UtAF Dopp­ler-pulsatility index had higher risk of progression to preeclampsia, preterm delivery &#x3c;34 weeks of gestation, small for gestational age infant, and fetal growth restriction (ORs ≥3.3). The presence of notch was associated with higher risk of progression to preeclampsia, preterm delivery &#x3c;37 and &#x3c;34 weeks of gestation, SGA infant, and fetal growth restriction (ORs ≥2.9). However, logistic regression analysis revealed that only serum sEng was a significant and independent risk factor for progression of GH to preeclampsia, preterm delivery &#x3c;34 weeks of gestation, and fetal growth restriction (ORs ≥3.1). <b><i>Conclusions:</i></b> In GH pregnancies, UtAF Doppler ultrasonography is associated with increased risk of adverse outcomes and progression to preeclampsia. However, serum sEng concentration appears to be a better predictor to assess the risk of adverse maternal and perinatal outcomes and progression to preeclampsia.

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