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 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. 

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

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

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

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

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

2019 ◽  
Vol 47 (2) ◽  
pp. 212-217
Author(s):  
Cecilia Villalaín ◽  
Ignacio Herraiz ◽  
Maria S. Quezada ◽  
Paula I. Gómez-Arriaga ◽  
Elisa Simón ◽  
...  
Keyword(s):  
Vaginal Delivery ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Umbilical Artery ◽  
Late Onset ◽  
Perinatal Outcomes ◽  
Labor Induction ◽  
Growth Restriction ◽  
Reversed Flow ◽  
Aortic Isthmus

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.

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.

scholarly journals EP18.01: Clinical and Doppler predictors of adverse perinatal outcomes in late onset fetal growth restriction

2019 ◽  
Vol 54 (S1) ◽  
pp. 344-344
Author(s):  
A. Dall'Asta ◽  
E. Roletti ◽  
N. Volpe ◽  
E. Pasquo ◽  
C. Kaihura ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Late Onset ◽  
Perinatal Outcomes ◽  
Growth Restriction ◽  
Adverse Perinatal Outcomes

scholarly journals VP37.16: Doppler surveillance across gestation and adverse perinatal outcomes in late onset fetal growth restriction

2020 ◽  
Vol 56 (S1) ◽  
pp. 220-220
Author(s):  
A. Dall'Asta ◽  
T. Ghi ◽  
T. Stampalija ◽  
G. Pedrazzi ◽  
M. Minopoli ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Late Onset ◽  
Perinatal Outcomes ◽  
Growth Restriction ◽  
Adverse Perinatal Outcomes

A Cut-off Value for Gestational Week at Birth for Better Perinatal Outcomes in Early- and Late-Onset Fetal Growth Restriction

2019 ◽  
Vol 223 (05) ◽  
pp. 289-296
Author(s):  
Mehmet Sinan Beksac ◽  
Erdem Fadiloglu ◽  
Atakan Tanacan ◽  
Apostolos Mamopoulos ◽  
Merve Basol ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Early Onset ◽  
Late Onset ◽  
Perinatal Outcomes ◽  
Expectant Management ◽  
Growth Restriction ◽  
Apgar Scores ◽  
First Choice ◽  
Gestational Week

Abstract Objective Prediction of cut-off value for gestational week at birth for better perinatal outcomes in early- and late-onset fetal growth restriction (FGR). Materials and Methods This study consists of 83 singleton pregnancies with FGR that were diagnosed antenatally and confirmed postnatally between January 2017–April 2018. We used the 34th gestational week as a cut-off for early- and late-onset FGR discrimination. Results Early- and late-onset FGRs were detected in 22 (26.5%) and 61 (73.5%) of the cases, respectively. Expectant management significantly improved birth weight and Apgar scores at the 1st, 5th, and 10th minute in early-onset FGR cases (p=0.001, p=0.019, p=0.002, and p=0.001,respectively). Similar analysis revealed no significant improvements in late-onset FGR (p=0.151, p=0.727, p=0.951 and p=0.477, respectively). Umbilical cord blood gas pH was found to be similar between management modalities in both the early- and late-onset groups (p=0.186 and p=0.456, respectively). Gestational week 33.5 was found to be the threshold for better Apgar scores at the 1st, 5th, and 10th minute according to ROC curve analysis. Percentiles of 4.5, 2.5, and 4.5 were cut-off values for better Apgar scores at the 1st, 5th, and 10th minute, respectively. Conclusion Expectant management must be the first choice to improve Apgar scores in early-onset FGR cases, and gestational week 33.5 must be considered as a threshold for delivery. Immediate delivery might be the choice in late-onset FGR in necessary cases. However, etiology-based management and perinatal surveillance might also be considered to improve prematurity-related neonatal complications.

Timing of Delivery in Pregnancies Complicated by Suspected Fetal Growth Restriction without Doppler Abnormalities

2019 ◽  
Vol 37 (06) ◽  
pp. 647-651
Author(s):  
Beth L. Pineles ◽  
Sarah Crimmins ◽  
Ozhan Turan
Keyword(s):  
Fetal Growth ◽  
Gestational Age ◽  
Fetal Growth Restriction ◽  
Primary Outcome ◽  
Perinatal Outcomes ◽  
Growth Restriction ◽  
Abdominal Circumference ◽  
Fetal Ultrasound ◽  
Mortality And Morbidity ◽  
Increased Risk

Abstract Objective This study aimed to identify the optimal gestational age for delivery of pregnancies complicated by fetal growth restriction (FGR) without Doppler abnormalities. Study Design Cases of FGR (ultrasound-estimated fetal weight less than the 10th or abdominal circumference less than the 5th percentile for gestational age) without fetal Doppler abnormalities were identified from a fetal ultrasound database. The primary outcome was a composite of perinatal mortality and morbidity. The risk of the primary outcome for each gestational age was compared with pregnancies delivered at 390/7 to 406/7 weeks. Odds ratios were adjusted for potential confounders. Results The analysis included 1,024 pregnancies. FGR was identified at a median of 235/7 weeks (range: 20–42 weeks). Four cases of fetal death (234/7—376/7 weeks) and no neonatal deaths were included. The primary outcome occurred in 209 patients (20.4%). This was greater for patients delivered at less than 37 weeks' gestation than for those delivered at or after 39 weeks' gestation, with no increased risk after 40 weeks. Conclusion Among pregnancies complicated by suspected FGR without Doppler abnormalities, delivery at 39 weeks is safe with no difference in perinatal outcomes from 37 to 42 weeks.

Sign in / Sign up

Export Citation Format

Share Document