Impact of Intended Mode of Delivery on Outcomes in Preterm Growth-Restricted Fetuses

Background Scheduled cesarean is frequently performed for fetal growth restriction due to concerns for fetal intolerance of labor. Objective We compared neonatal outcomes in preterm growth-restricted fetuses by intended mode of delivery. Study Design We performed a retrospective cohort study of indicated preterm births with prenatally diagnosed growth restriction from 2011 to 2014 at a single institution. Patients were classified by intended mode of delivery. The primary outcome was a composite of adverse neonatal outcomes, including perinatal death, cord blood acidemia, chest compressions during neonatal resuscitation, seizures, culture-proven sepsis, necrotizing enterocolitis, and grade III–IV intraventricular hemorrhage. Secondary analysis was performed examining the impact of umbilical artery Dopplers. Results Of 101 fetuses with growth restriction, 75 underwent planned cesarean deliveries. Of those induced, 46.2% delivered vaginally. Delivery by scheduled cesarean was not associated with a decreased risk of the composite outcome (adjusted odds ratio [aOR], 1.61; 95% confidence interval [CI], 0.45–5.78), even when only those with abnormal umbilical artery Dopplers were considered (aOR, 2.8; 95% CI, 0.40–20.2). Conclusion In this cohort, planned cesarean was not associated with a reduction in neonatal morbidity, even when considering only those with abnormal umbilical artery Dopplers. In otherwise appropriate candidates for vaginal delivery, fetal growth restriction should not be considered a contraindication to trial of labor.

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Umbilical Artery Half-Peak Systolic Velocity Deceleration Time in Fetal Growth Restriction

Fetal Diagnosis and Therapy ◽

10.1159/000442049 ◽

2015 ◽

Vol 40 (2) ◽

pp. 128-134 ◽

Cited By ~ 1

Author(s):

Juan Carlos Bustos ◽

Vivian Gonzalez ◽

Waldo Sepulveda

Keyword(s):

Fetal Growth ◽

Fetal Growth Restriction ◽

Perinatal Outcome ◽

Umbilical Artery ◽

Perinatal Death ◽

Peak Systolic Velocity ◽

Growth Restriction ◽

Ultrasound Evaluation ◽

Diastolic Velocity ◽

Deceleration Time

Objective: To study the umbilical artery (UA) half-peak systolic velocity deceleration time (hPSV-DT) in pregnancies complicated by fetal growth restriction (FGR). Methods: The study included 266 singleton, high-risk pregnancies with an estimated fetal weight <10th percentile, which were examined between 24 and 40 weeks' gestation and delivered within a week from the last ultrasound evaluation. UA hPSV-DT was measured with Doppler ultrasound in the same wave used to measure the pulsatility index. UA hPSV-DT values were correlated with perinatal outcome. Results: UA hPSV-DT <5th percentile was found in 87 and 98% of fetuses with moderate and severe FGR, respectively. 94% of fetuses with a UA hPSV-DT <90 ms had poor perinatal outcome including perinatal death or prolonged admission to the neonatal intensive care unit. None of the fetuses had a UA hPSV-DT <70 ms. Perinatal death occurred in 39 fetuses; UA hPSV-DT was abnormal in all of them, with 95% of these fetuses having values of ≤120 ms. In the group of fetuses with absent/reverse end-diastolic velocity in the UA, the perinatal mortality rate was 51% for those with a UA hPSV-DT ≤90 ms and only 23% for those having a UA hPSV-DT >90 ms (p < 0.01). Conclusions: UA hPSV-DT seems to be a useful technique in the evaluation of pregnancies at risk for FGR and perinatal death. Additionally, hPSV-DT was shown to be a good predictor of perinatal death, with values of <90 ms corresponding to imminent risk of intrauterine demise and values of <70 ms being likely to be incompatible with intrauterine life.

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The ability of various cerebroplacental ratio thresholds to predict adverse neonatal outcomes in term fetuses exhibiting late-onset fetal growth restriction

Journal of Perinatal Medicine ◽

10.1515/jpm-2020-0244 ◽

2020 ◽

Vol 0 (0) ◽

Cited By ~ 1

Author(s):

Rauf Melekoglu ◽

Ercan Yilmaz ◽

Seyma Yasar ◽

Irem Hatipoglu ◽

Bekir Kahveci ◽

...

Keyword(s):

Pregnant Women ◽

Fetal Growth ◽

Fetal Growth Restriction ◽

Umbilical Artery ◽

Late Onset ◽

Growth Restriction ◽

Neonatal Outcomes ◽

Fetal Medicine ◽

Cerebroplacental Ratio ◽

Adverse Neonatal Outcomes

AbstractObjectivesOur primary aim was to evaluate the ability of various cerebroplacental ratio (CPR) reference values suggested by the Fetal Medicine Foundation to predict adverse neonatal outcomes in term fetuses exhibiting late-onset fetal growth restriction (LOFGR). Our secondary aim was to evaluate the effectiveness of other obstetric Doppler parameters used to assess fetal well-being in terms of predicting adverse neonatal outcomes.MethodsThis was a retrospective cohort study of 317 pregnant women diagnosed with LOFGR at 37–40 weeks of gestation between January 1, 2016, and September 1, 2019. Receiver operating characteristic (ROC) curves were drawn to determine the predictive performance of CPR <1, CPR <5th or <10th percentile, and umbilical artery pulsatility (PI) >95th percentile in terms of predicting adverse neonatal outcomes.ResultsPregnant women exhibiting LOFGR who gave birth in our clinic during the study period at a mean of 38 gestational weeks (minimum 37+0; maximum 40+6 weeks); the median CPR was 1.51 [interquartile range (IQR) 1.12–1.95] and median birthweight 2,350 g (IQR 2,125–2,575 g). The CPR <5th percentile best predicted adverse neonatal outcomes [area under the curve (AUC) 0.762, 95% confidence interval (CI) 0.672–0.853, p<0.0001] and CPR <1 was the worst predictor (AUC 0.630, 95% CI 0.515–0.745, p=0.021). Of other Doppler parameters, neither the umbilical artery systole/diastole ratio nor the mid-cerebral artery to peak systolic velocity ratio (MCA–PSV) predicted adverse neonatal outcomes (AUC 0.598, 95% CI 0.480–0.598, p=0.104; AUC 0.521, 95% CI 0.396–0.521, p=0.744 respectively).ConclusionsThe CPR values below the 5th percentile better predicted adverse neonatal outcomes in pregnancies complicated by LOFGR than the UA PI and CPR <1 by using Fetal Medicine Foundation reference ranges.

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The role of sildenafil citrate in the treatment of fetal growth restriction: a randomized controlled trial

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20191929 ◽

2019 ◽

Vol 8 (5) ◽

pp. 1840

Author(s):

Ahmed Abdelshafy ◽

Khaled Ibrahim Abdullah ◽

Sherif Ashoush ◽

Heba E. Hosni

Keyword(s):

Middle Cerebral Artery ◽

Fetal Growth ◽

Cerebral Artery ◽

Fetal Growth Restriction ◽

Umbilical Artery ◽

Controlled Trial ◽

Maternity Hospital ◽

Growth Restriction ◽

Sildenafil Citrate ◽

Doppler Velocity

Background: This study was aimed to evaluate the effect of sildenafil citrate on Doppler velocity indices in patients with fetal growth restriction (FGR) associated with impaired placental circulation.Methods: A double-blinded, parallel group randomized clinical trial (clinicaltrials.gov NCT02590536) was conducted in Ain Shams Maternity Hospital, in the period between October 2015 and June 2017. Ninety pregnant women with documented intrauterine growth retardation at 24-37 weeks of gestation were randomized to either sildenafil citrate 25 mg orally every 8 hours or placebo visually-identical placebo tablets with the same regimen. The primary outcome of the study was the change in umbilical artery and fetal middle cerebral artery indices.Results: There was a significant improvement in umbilical and middle cerebral artery indices after sildenafil administration p<0.001. Present study observed that, sildenafil group, in comparison to placebo, has a significantly higher mean neonatal birth weight. 1783±241g vs 1570±455g (p<0.001). There was a significantly higher mean gestational age at delivery in women in sildenafil group 35.3±1.67 weeks, whereas it was lower in the placebo group 33.5±1.7 weeks. The side effects as headache, palpitation and facial flushing were significantly higher in sildenafil group compared to placebo group.Conclusions: The use sildenafil citrate in pregnancies with fetal growth restriction (FGR) improved the feto-placental Doppler indices (pulsatility index of umbilical artery and middle cerebral artery) and improved neonatal outcomes.

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