Antenatal Fetal Adrenal Measurements at 22 to 30 Weeks' Gestation, Fetal Growth Restriction, and Perinatal Morbidity

2019 ◽  
Author(s):  
Nathan R. Blue ◽  
Matthew Hoffman ◽  
Amanda A. Allshouse ◽  
William A. Grobman ◽  
Hyagriv N. Simhan ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Perinatal Outcome ◽  
Neonatal Intensive Care ◽  
Secondary Analysis ◽  
Area Under The Curve ◽  
Growth Restriction ◽  
Perinatal Morbidity ◽  
Absolute Measurements ◽  
Transverse Area

Objective Our objective was to test the association of fetal adrenal size with perinatal morbidity among fetuses with fetal growth restriction (FGR; estimated fetal weight [EFW] < 10th percentile). Study Design This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b) adrenal study, which measured fetal adrenal gland size at 22 to 30 weeks' gestation. We analyzed the transverse adrenal area (TAA) and fetal zone area (absolute measurements and corrected for fetal size) and the ratio of the fetal zone area to the total transverse area using a composite perinatal outcome of stillbirth, neonatal intensive care unit admission, respiratory distress syndrome, necrotizing enterocolitis, retinopathy of prematurity, sepsis, mechanical ventilation, seizure, or death. Among fetuses with FGR, adrenal measurements were compared between those that did and did not experience the composite perinatal outcome. Results There were 1,709 eligible neonates. Seven percent (n = 120) were diagnosed with FGR at the time of adrenal measurement, and 14.7% (n = 251) experienced perinatal morbidity. EFW-corrected and absolute adrenal measurements were similar among fetuses with and without FGR as well as among those who did and did not experience morbidity. The area under the curve for corrected TAA was 0.52 (95% confidence interval 0.38–0.67). Conclusion In our cohort, adrenal size was not associated with risk of morbidity among fetuses with FGR.

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 Perinatal outcome of stage-based management of fetal growth restriction in a government tertiary care hospital in Kerala, India

2021 ◽  
Vol 10 (6) ◽  
pp. 2354
Author(s):  
Bhargavi Rangarajan ◽  
Lalithambica Karunakaran
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Perinatal Outcome ◽  
Late Onset ◽  
Medical Condition ◽  
Tertiary Care ◽  
Perinatal Outcomes ◽  
Growth Restriction ◽  
Care Hospital ◽  
Medical College

BACKGROUND: Fetal Growth Restriction (FGR) is the largest contributing factor to perinatal morbidity, mortality and impaired neurodevelopment. This research strives to elucidate the perinatal outcomes of stage based management of fetal growth restriction using Obstetric Doppler and its  association with maternal sociodemographic profile.METHODS: The research was  conducted among 320 antenatal women whose Estimated Fetal weight was  <10th centile. Periodic follow up with Doppler was done and managed as per the stage of FGR. Perinatal outcomes were compiled.RESULTS: The incidence of FGR in T.D Medical College, Alappuzha  was 15.23%. SGA  accounted for 47 %.  The proportion of early and late onset FGR was  10.3%    &   89.7%    respectively.  57.18% of the newborns were admitted to NICU.  The common complications were: Low birth weight – 47.8% ARDS – 21% , Sepsis – 9.6%, Necrotizing enterocolitis – 4%, Hyperbilirubinemia – 4.9%. The incidence of Neonatal death and stillbirth were 1.56% and 0.3% respectively. Mothers who were underweight, inadequate weight gain during pregnancy and short inter pregnancy interval had increased risks. Hypertensive disorders of pregnancy was the commonly associated medical condition. CONCLUSION: Prolongation of pregnancy  even by one day results in 2% increased chances of survival of the newborn. Hence, it becomes imperative to identify the benign forms of FGR  to prevent iatrogenic prematurity. Antenatal women should be screened for risk factors and undergo vigilant antepartum surveillance to bring about favourable perinatal outcome. 

Fetal aortic isthmus Doppler measurements for prediction of perinatal morbidity and mortality associated with fetal growth restriction

2013 ◽  
Vol 92 (6) ◽  
pp. 656-661 ◽  
Author(s):  
Khalil Abdelrazzaq ◽  
Ahmet Özgür Yeniel ◽  
Ahmet Mete Ergenoglu ◽  
Nuri Yildirim ◽  
Fuat Akercan ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Growth Restriction ◽  
Morbidity And Mortality ◽  
Perinatal Morbidity ◽  
Aortic Isthmus

scholarly journals Prenatal Use of Sildenafil in Fetal Growth Restriction and Its Effect on Neonatal Tissue Oxygenation—A Retrospective Analysis of Hemodynamic Data From Participants of the Dutch STRIDER Trial

2020 ◽  
Vol 8 ◽  
Author(s):  
Fieke Terstappen ◽  
Anne E. Richter ◽  
A. Titia Lely ◽  
Freek E. Hoebeek ◽  
Ayten Elvan-Taspinar ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Placebo Group ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Neonatal Intensive Care ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Growth Restriction ◽  
Tissue Oxygen Saturation

Objective: Sildenafil is under investigation as a potential agent to improve uteroplacental perfusion in fetal growth restriction (FGR). However, the STRIDER RCT was halted after interim analysis due to futility and higher rates of persistent pulmonary hypertension and mortality in sildenafil-exposed neonates. This hypothesis-generating study within the Dutch STRIDER trial sought to understand what happened to these neonates by studying their regional tissue oxygen saturation (rSO2) within the first 72 h after birth.Methods: Pregnant women with FGR received 25 mg placebo or sildenafil thrice daily within the Dutch STRIDER trial. We retrospectively analyzed the cerebral and renal rSO2 monitored with near-infrared spectroscopy (NIRS) in a subset of neonates admitted to two participating neonatal intensive care units, in which NIRS is part of standard care. Secondarily, blood pressure and heart rate were analyzed to aid interpretation. Differences in oxygenation levels and interaction with time (slope) between placebo- and sildenafil-exposed groups were tested using mixed effects analyses with multiple comparisons tests.Results: Cerebral rSO2 levels were not different between treatment groups (79 vs. 77%; both n = 14) with comparable slopes. Sildenafil-exposed infants (n = 5) showed lower renal rSO2 than placebo-exposed infants (n = 6) during several time intervals on day one and two. At 69–72 h, however, the sildenafil group showed higher renal rSO2 than the placebo group. Initially, diastolic blood pressure was higher and heart rate lower in the sildenafil than the placebo group, which changed during day two.Conclusions: Although limited by sample size, our data suggest that prenatal sildenafil alters renal but not cerebral oxygenation in FGR neonates during the first 72 post-natal hours. The observed changes in renal oxygenation could reflect a vasoconstrictive rebound from sildenafil. Similar changes observed in accompanying vital parameters support this hypothesis.

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

2015 ◽  
Vol 40 (2) ◽  
pp. 128-134 ◽  
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.

scholarly journals Circulating C19MC MicroRNAs in Preeclampsia, Gestational Hypertension, and Fetal Growth Restriction

2013 ◽  
Vol 2013 ◽  
pp. 1-12 ◽  
Author(s):  
Ilona Hromadnikova ◽  
Katerina Kotlabova ◽  
Marketa Ondrackova ◽  
Andrea Kestlerova ◽  
Veronika Novotna ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Perinatal Outcome ◽  
Pulsatility Index ◽  
Gestational Hypertension ◽  
Clinical Signs ◽  
Growth Restriction ◽  
Cerebroplacental Ratio ◽  
Severity Of The Disease ◽  
Ultrasound Parameters

The objective of the study was to identify the profile of circulating C19MC microRNAs (miR-516-5p, miR-517*, miR-518b, miR-520a*, miR-520h, miR-525, and miR-526a) in patients with established preeclampsia (n=63), fetal growth restriction (n=27), and gestational hypertension (n=23). We examined the correlation between plasmatic concentrations and expression levels of microRNAs and the severity of the disease with respect to clinical signs, requirements for the delivery, and Doppler ultrasound parameters. Using absolute and relative quantification approaches, increased extracellular C19MC microRNA levels (miR-516-5p,P=0.037,P=0.009; miR-517*,P=0.033,P=0.043; miR-520a*,P=0.001,P=0.009; miR-525,P=0.026,P=0.01; miR-526a,P=0.03,P=0.035) were detected in patients with preeclampsia. The association analysis pointed to no relationship between C19MC microRNA plasmatic concentrations and expression profile and identified risk factors for a poorer perinatal outcome. However, the dependence between the levels of plasmatic C19MC microRNAs and the pulsatility index in the middle cerebral artery and the values of cerebroplacental ratio was demonstrated. The study brought the interesting finding that the upregulation of miR-516-5p, miR-517*, miR-520a*, miR-525, and miR-526a is a characteristic phenomenon of established preeclampsia.

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