scholarly journals Selective Fetal Growth Restriction in Dichorionic Twin Pregnancies: Diagnosis, Natural History, and Perinatal Outcome

2020 ◽  
Vol 9 (5) ◽  
pp. 1404 ◽  
Author(s):  
Nikolaos Antonakopoulos ◽  
Petra Pateisky ◽  
Becky Liu ◽  
Erkan Kalafat ◽  
Baskaran Thilaganathan ◽  
...  
Keyword(s):  
Natural History ◽  
Disease Progression ◽  
Diagnostic Criteria ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Perinatal Death ◽  
First Trimester ◽  
Growth Restriction ◽  
Progression Rate ◽  
Delphi Consensus

This study aims to evaluate the natural history, disease progression, and outcomes in dichorionic twins with selective fetal growth restriction (sFGR) according to different diagnostic criteria and time of onset. Dichorionic twins seen from the first trimester were included. sFGR was classified according to the Delphi consensus, and was compared to the outcomes of those classified by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) diagnostic criteria. Early sFGR occurred before 32-weeks, and late sFGR after 32-weeks. Disease progression, neonatal outcomes such as gestation at delivery, birthweight, neonatal unit (NNU) admission, and morbidities were compared. One-hundred twenty-three of 1053 dichorionic twins had sFGR, where 8.4% were classified as early sFGR, and 3.3% were late sFGR. Disease progression was seen in 36%, with a longer progression time (5 vs. 1 week) and higher progression rate (40% vs. 26%) in early sFGR. Perinatal death was significantly higher in the sFGR than the non-sFGR group (24 vs. 16 per 1000 births, p = 0.018), and those with early sFGR had more NNU admissions than late sFGR (p = 0.005). The ISUOG diagnostic criteria yielded a higher number of sFGR than the Delphi criteria, but similar outcomes. sFGR have worse perinatal outcomes, with early onset being more prevalent. Use of the Delphi diagnostic criteria can reduce over-diagnosis of sFGR and avoid unnecessary intervention.

scholarly journals Protect-me: a parallel-group, triple blinded, placebo-controlled randomised clinical trial protocol assessing antenatal maternal melatonin supplementation for fetal neuroprotection in early-onset fetal growth restriction

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e028243 ◽  
Author(s):  
Kirsten R Palmer ◽  
Joanne C Mockler ◽  
Miranda L Davies-Tuck ◽  
Suzanne L Miller ◽  
Stacy K Goergen ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Early Onset ◽  
Perinatal Death ◽  
Controlled Trial ◽  
Brain Mri ◽  
Randomised Clinical Trial ◽  
Growth Restriction ◽  
Cognitive Domain ◽  
Singleton Pregnancy

IntroductionFetal growth restriction (FGR) is a serious pregnancy complication, associated with increased rates of perinatal death and morbidity among survivors. Most commonly FGR results from placental insufficiency, where the placenta fails to deliver the oxygen and nutrients required for normal fetal growth. This leads to fetal oxidative stress, resulting in organ damage through lipid peroxidation. The early developing brain is particularly susceptible, such that FGR is associated with poorer neurodevelopment, witnessed as cognitive and behavioural dysfunction, and cerebral palsy. Promisingly, melatonin, a lipid soluble antioxidant is neuroprotective in animal models of FGR. We present a protocol outlining a randomised, placebo-controlled trial to explore whether antenatal maternal melatonin supplementation in pregnancies with severe, early-onset FGR can improve neurodevelopment among survivors at 2 years of age.Methods and analysesWe will recruit 336 women with a singleton pregnancy complicated by FGR between 23+0 and 31+6 weeks gestation. Participants will be randomised, stratified by gestational age, to either 30 mg melatonin per day or a visually identical placebo, continued until birth. Measures of maternal and fetal health will be collected until birth. Timing of birth will be determined by the treating clinical team in discussion with the woman. Neonatal and infant neurodevelopmental assessments will be undertaken, consisting of brain MRI at term corrected age, general movements assessment at term and 3 months’ corrected age, and Bayley Scales of Infant & Toddler Development-III and Infant Toddler Social Emotional Assessment at 2.5 years corrected age. Analyses will be on intention to treat. The primary outcome is a difference of 5 points in the cognitive domain of the Bayley-III. Secondary outcomes address maternal and fetal safety.Ethics and disseminationThis trial has Monash Health Human Research and Ethics committee approval (17-0000-583A). Findings will be disseminated through peer-reviewed publications, conference presentations and to participants.Trial registration numberACTRN12617001515381; Pre-results

Retinol binding protein as early marker of fetal growth restriction in first trimester maternal serum

2013 ◽  
Vol 29 (4) ◽  
pp. 323-326 ◽  
Author(s):  
Arrigo Fruscalzo ◽  
Anna Biasioli ◽  
Ambrogio P Londero ◽  
Maria Ceraudo ◽  
Giuliana Stel ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Binding Protein ◽  
First Trimester ◽  
Maternal Serum ◽  
Growth Restriction ◽  
Retinol Binding Protein ◽  
Early Marker
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