Prognostic value of the aortic isthmus Doppler assessment on late onset fetal growth restriction

AbstractBackgroundAs conflicting results have been reported about the association of reversed flow on the aortic isthmus (AoI) and adverse perinatal results in fetal growth restriction (FGR), we aim to compare perinatal outcomes (including tolerance to labor induction) of late-onset FGR between those with anterograde and reversed AoI flow.MethodsThis was an observational retrospective cohort study on 148 singleton gestations diagnosed with late-onset FGR (diagnosis ≥32+0 weeks), with an estimated fetal weight (EFW) <10thcentile and mild fetal Doppler alteration: umbilical artery (UA) pulsatility index (PI) >95thcentile, middle cerebral artery (MCA)-PI <5thcentile or cerebral-placental ratio <5thcentile. Anterograde AoI flow was present in n=79 and reversed AoI flow in n=69. Delivery was recommended from 37 weeks in both groups. Perinatal results were compared between the groups.ResultsThe global percentage of vaginal delivery of fetuses with anterograde and reversed blood flow was 55.7% vs. 66.7% (P=0.18) and the percentage of cesarean section (C-section) for non-reassuring fetal status was 12.7% vs. 15.9% (P=0.29), respectively. When evaluating those that underwent labor induction, the vaginal delivery rate was 67.9% vs. 77.2% (P=0.17), respectively. There were no significant differences regarding any other perinatal variables and there were no cases of severe morbidity or mortality.ConclusionWe observed that the presence of reversed AoI flow does not worsen perinatal outcomes on fetuses with late-onset growth restriction with mild Doppler alterations. Attempt of labor induction is feasible in these fetuses regardless of the direction of AoI flow.

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EP19.06: Gestational age at delivery, Doppler indices and perinatal outcomes in preterm late onset fetal growth restriction as for Delphi's criteria

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.21508 ◽

2019 ◽

Vol 54 (S1) ◽

pp. 352-353

Author(s):

K. Melchiorre ◽

M. Rosati ◽

E. Clementini ◽

I. D'Emilio ◽

S. Di Valerio ◽

...

Keyword(s):

Fetal Growth ◽

Gestational Age ◽

Fetal Growth Restriction ◽

Late Onset ◽

Perinatal Outcomes ◽

Growth Restriction ◽

Gestational Age At Delivery ◽

Doppler Indices

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Perinatal Outcomes With Normal Compared With Elevated Umbilical Artery Systolic-to-Diastolic Ratios in Fetal Growth Restriction

Obstetric Anesthesia Digest ◽

10.1097/01.aoa.0000479515.96285.86 ◽

2016 ◽

Vol 36 (1) ◽

pp. 37-38

Author(s):

L. Maggio ◽

D. Dahlke ◽

H. Mendez-Figueroa ◽

C.M. Albright ◽

S.P. Chauhan ◽

...

Keyword(s):

Fetal Growth ◽

Fetal Growth Restriction ◽

Umbilical Artery ◽

Perinatal Outcomes ◽

Growth Restriction

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

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20212175 ◽

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.

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721: Sonographic determinants of adverse perinatal outcomes at longitudinal surveillance in late-onset fetal growth restriction

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2019.11.735 ◽

2020 ◽

Vol 222 (1) ◽

pp. S457

Author(s):

Andrea Dall'Asta ◽

Tullio Ghi ◽

Giuseppe Pedrazzi ◽

Enrica Roletti ◽

Monica Minopoli ◽

...

Keyword(s):

Fetal Growth ◽

Fetal Growth Restriction ◽

Late Onset ◽

Perinatal Outcomes ◽

Growth Restriction ◽

Adverse Perinatal Outcomes

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Adverse perinatal outcomes in fetuses with severe late-onset fetal growth restriction

The Journal of Maternal-Fetal & Neonatal Medicine ◽

10.1080/14767058.2021.1995858 ◽

2021 ◽

pp. 1-7

Author(s):

Maria Luiza Rozo Bahia ◽

Guillermo Coca Velarde ◽

Fernanda Campos da Silva ◽

Edward Araujo Júnior ◽

Renato Augusto Moreira de Sá

Keyword(s):

Fetal Growth ◽

Fetal Growth Restriction ◽

Late Onset ◽

Perinatal Outcomes ◽

Growth Restriction ◽

Adverse Perinatal Outcomes

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

Journal of Perinatal Medicine ◽

10.1515/jpm-2020-0210 ◽

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.

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Umbilical artery thrombosis diagnosed at different gestational ages and fetal outcomes: a case series

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04264-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jing Wei ◽

Qiaoyun Li ◽

Hongbo Zhai

Keyword(s):

Cesarean Section ◽

Vaginal Delivery ◽

Fetal Growth ◽

Fetal Growth Restriction ◽

Umbilical Artery ◽

Growth Restriction ◽

Close Monitoring ◽

Ultrasound Scan ◽

Umbilical Blood ◽

Artery Thrombosis

Abstract Background Umbilical artery thrombosis is a rare complication of pregnancy strongly associated with poor fetal and perinatal outcomes, such as intrauterine asphyxia, fetal growth restriction, and stillbirth. Its pathogenesis remains unclear, and there is the added challenge of selecting an appropriate delivery time to achieve excellent neonatal outcomes. Methods Our Hospital is a critical maternal rescue center with approximately 7000 births annually. We present a series of 8 cases of umbilical artery thrombosis diagnosed at the hospital between Apr 1, 2018, and Jan 31, 2020. We identified the cases through a keyword search of the maternity and pathology information management systems. Results Three patients were diagnosed with a transabdominal ultrasound scan and hypoxia on fetal heart monitoring. All three patients had emergency cesarean section delivery. Four patients were observed closely for 5 to 13 weeks from initial detection by an ultrasound scan to delivery. Only one patient was diagnosed after vaginal delivery by Hematoxylin-eosin staining of umbilical cord sections. Seven patients had deliveries by cesarean section, and one patient had a vaginal delivery. All infants were born alive. Conclusions Umbilical artery thrombosis is a challenging and rare condition that can occur at different gestational ages, especially when diagnosed in the third trimester and accompanied by fetal growth restriction. Consequently, these patients require close monitoring of umbilical blood flow and fetal growth and intervention at the appropriate time to achieve an optimal outcome.

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Prognostic Factors of Successful Cervical Ripening and Labor Induction in Late-Onset Fetal Growth Restriction

Fetal Diagnosis and Therapy ◽

10.1159/000503390 ◽

2019 ◽

Vol 47 (7) ◽

pp. 536-544

Author(s):

Cecilia Villalain ◽

María Soledad Quezada ◽

Paula Gómez-Arriaga ◽

Elisa Simón ◽

Enery Gómez-Montes ◽

...

Keyword(s):

Prognostic Factors ◽

Fetal Growth ◽

Fetal Growth Restriction ◽

Late Onset ◽

Labor Induction ◽

Growth Restriction ◽

Cervical Ripening

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MiRNAs Regulating Oxidative Stress: A Correlation with Doppler Sonography of Uteroplacental Complex and Clinical State Assessments of Newborns in Fetal Growth Restriction

Journal of Clinical Medicine ◽

10.3390/jcm9103227 ◽

2020 ◽

Vol 9 (10) ◽

pp. 3227

Author(s):

Vladislava Gusar ◽

Mariya Ganichkina ◽

Vitaliy Chagovets ◽

Nataliya Kan ◽

Gennadiy Sukhikh

Keyword(s):

Oxidative Stress ◽

Cord Blood ◽

Umbilical Cord ◽

Fetal Growth ◽

Umbilical Cord Blood ◽

Fetal Growth Restriction ◽

Early Onset ◽

Umbilical Artery ◽

Late Onset ◽

Perinatal Outcomes

Overproduction of reactive oxygen species (ROS) and, as a result, uncontrolled oxidative stress (OS) can play a central role in disorders of fetal hemodynamics and subsequent development of adverse perinatal outcomes in newborns with fetal growth restriction (FGR). Given the epigenetic nature of such disorders, the aim of our study was to evaluate the expression of miRNAs associated with OS and endothelial dysfunction (miR-27a-3p, miR-30b-5p, miR-125b-5p, miR-221-3p, miR-451a and miR-574-3p) in umbilical cord blood using real-time quantitative RT-PCR. ΜiRNA expression was evaluated in patients with FGR delivery before (n = 9 pregnant) and after 34 weeks of gestation (n = 13 pregnant), and the control groups corresponding to the main groups by gestational age (13 pregnant women in each group, respectively). A significant increase in miR-451a expression was detected in late-onset FGR and correlations with fetoplacental and cerebral circulation were established (increase of resistance in the umbilical artery (pulsatility index, PI UA (umbilical artery): r = −0.59, p = 0.001) and a decrease in cerebral blood flow (CPR: r = 0.48, p = 0.009)). The change in miR-125b-5p expression in the placenta is associated with reduced Doppler of cerebral hemodynamics (CPR: r = 0.73, p = 0.003; PI MCA (middle cerebral artery): r = 0.79, p = 0.0007), and newborn weight (r = 0.56, p = 0.04) in early-onset FGR. In addition, significant changes in miR-125b-5p and miR-451a expression in umbilical cord blood plasma were found in newborns with neonatal respiratory distress syndrome (NRDS) (in early-onset FGR) and very low birth weight (VLBW) (in late-onset FGR). A number of key signaling pathways have been identified in which the regulation of the studied miRNAs is involved, including angiogenesis, neurotrophin signaling pathway and oxidative stress response. In general, our study showed that changes of the redox homeostasis in the mother-placenta-fetus system in FGR and subsequent perinatal outcomes may be due to differential expression of oxidative stress-associated miRNAs.

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