427. STRIDER: Sildenafil therapy in dismal prognosis early-onset fetal growth restriction – A systematic review with individual participant data

2018 ◽  
Vol 13 ◽  
pp. S8 ◽  
Author(s):  
Wessel Ganzevoort ◽  
Peter von Dadelszen ◽  
Phil Baker ◽  
Chirag Kariya ◽  
Kennth Lim ◽  
...  
Keyword(s):  
Systematic Review ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Early Onset ◽  
Growth Restriction ◽  
Individual Participant Data ◽  
Dismal Prognosis ◽  
Individual Participant

scholarly journals Short-term outcomes of phosphodiesterase type 5 inhibitors for fetal growth restriction: a study protocol for a systematic review with individual participant data meta-analysis, aggregate meta-analysis, and trial sequential analysis

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Jessica Liauw ◽  
Katie Groom ◽  
Wessel Ganzevoort ◽  
Christian Gluud ◽  
Christopher J. D. McKinlay ◽  
...  
Keyword(s):  
Systematic Review ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Early Onset ◽  
Sequential Analysis ◽  
Meta Analysis ◽  
Growth Restriction ◽  
Trial Sequential Analysis ◽  
Individual Participant Data ◽  
Individual Participant

Abstract Background Early onset fetal growth restriction secondary to placental insufficiency can lead to severe maternal and neonatal morbidity and mortality. Pre-clinical studies and a few small randomised clinical trials have suggested that phosphodiesterase type 5 (PDE-5) inhibitors may have protective effects against placental insufficiency in this context; however, robust evidence is lacking. The STRIDER Consortium conducted four randomised trials to investigate the use of a PDE-5 inhibitor, sildenafil, for the treatment of early onset fetal growth restriction. We present a protocol for the pre-planned systematic review with individual participant data meta-analysis, aggregate meta-analysis, and trial sequential analysis of these and other eligible trials. The main objective of this study will be to evaluate the effects of PDE-5 inhibitors on neonatal morbidity compared with placebo or no intervention among pregnancies with fetal growth restriction. Methods We will search the following electronic databases with no language or date restrictions: OVID MEDLINE, OVID EMBASE, the Cochrane Controlled Register of Trials (CENTRAL), and the clinical trial registers Clinicaltrials.gov and World Health Organisation International Clinical Trials Registry Platform (ICTRP). We will identify randomised trials of PDE-5 inhibitors in singleton pregnancies with growth restriction. Two reviewers will independently screen all citations, full-text articles, and abstract data. Our primary outcome will be infant survival without evidence of serious adverse neonatal outcome. Secondary outcomes will include gestational age at birth and birth weight z-scores. We will assess bias using the Cochrane Risk of Bias 2 tool. We will conduct aggregate meta-analysis using fixed and random effects models, Trial Sequential Analysis, and individual participant data meta-analysis using one- and two-stage approaches. The certainty of evidence will be assessed with GRADE. Discussion This pre-defined protocol will minimise bias during analysis and interpretation of results, toward the goal of providing robust evidence regarding the use of PDE-5 inhibitors for the treatment of early onset fetal growth restriction. Systematic review registration PROSPERO (CRD42017069688).

scholarly journals Early‐onset fetal growth restriction: A systematic review on mortality and morbidity

2019 ◽  
Vol 99 (2) ◽  
pp. 153-166 ◽  
Author(s):  
Anouk Pels ◽  
Irene M. Beune ◽  
Aleid G. van Wassenaer‐Leemhuis ◽  
Jacqueline Limpens ◽  
Wessel Ganzevoort
Keyword(s):  
Systematic Review ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Early Onset ◽  
Growth Restriction ◽  
Mortality And Morbidity

641 Fetal growth restriction and risk of intrapartum cesarean among women with early onset preeclampsia

2021 ◽  
Vol 224 (2) ◽  
pp. S403
Author(s):  
Emily N. Flagler ◽  
Erin M. Cleary ◽  
Michelle R. Petrich ◽  
Emily A. Armstrong ◽  
Patricia K. Belle ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Early Onset ◽  
Growth Restriction ◽  
Early Onset Preeclampsia

scholarly journals Risk stratification for early-onset fetal growth restriction in women with abnormal serum biomarkers: a retrospective cohort study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
L. Ormesher ◽  
L. Warrander ◽  
Y. Liu ◽  
S. Thomas ◽  
L. Simcox ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Early Onset ◽  
Late Onset ◽  
Area Under The Curve ◽  
Maternal Serum ◽  
Serum Biomarkers ◽  
Growth Restriction ◽  
Aneuploidy Screening ◽  
Internal Validation

AbstractAbnormal maternal serum biomarkers (AMSB), identified through the aneuploidy screening programme, are frequent incidental findings in pregnancy. They are associated with fetal growth restriction (FGR), but previous studies have not examined whether this association is with early-onset (< 34 weeks) or late-onset (> 34 weeks) FGR; as a result there is no consensus on management. The aims of this study were to determine the prevalence and phenotype of FGR in women with AMSB and test the predictive value of placental sonographic screening to predict early-onset FGR. 1196 pregnant women with AMSB underwent a 21–24 week “placental screen” comprising fetal and placental size, and uterine artery Doppler. Multivariable regression was used to calculate a predictive model for early-onset FGR (birthweight centile < 3rd/< 10th with absent umbilical end-diastolic flow, < 34 weeks). FGR prevalence was high (10.3%), however early-onset FGR was uncommon (2.3%). Placental screening effectively identified early-onset (area under the curve (AUC) 0.93, 95% confidence interval (CI) 0.87–1.00), but not late-onset FGR (AUC 0.70, 95% CI 0.64–0.75). Internal validation demonstrated robust performance for detection/exclusion of early-onset FGR. In this cohort, utilisation of our proposed algorithm with targeted fetal growth and Doppler surveillance, compared with universal comprehensive surveillance would have avoided 1044 scans, potentiating significant cost-saving for maternity services.

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.

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