Brief Introduction: Fetal growth restriction (FGR) affects up to 10% of pregnancies and confers an increased risk of perinatal morbidity and mortality. The aim of the Prospective Observational Trial to Optimise Paediatric Health in FGR (PORTO) Study was to evaluate the optimal management of fetuses with EFW <10th centile. This analysis describes the 57 perinatal morbidity cases which occurred in this cohort of non-anomalous infants with prenatally identified FGR.
Materials & Methods: The cohort consisted of 1,200 prospectively recruited fetuses with EFW <10th centile between 24 + 0 and 36 + 6 weeks’ gestation. Details on sonographic parameters including multi-vessel Doppler assessment were recorded together with information on pregnancy details and perinatal outcome. Adverse perinatal outcome was defined as composite outcome of intraventricular haemorrhage (IVH), periventricular leucomalacia (PVL), hypoxic ischaemic encephalopathy (HIE), necrotising enterocolitis (NEC), bronchopulmonary dysplasia (BPD), sepsis or death.
Clinical Cases or Summary Results: Of the 1,116 fetuses completing the study protocol, 312 (28%) were admitted to the neonatal intensive care unit and 57 (5%) were affected by adverse perinatal outcome including 6 mortalities. As outlined in table 1, adverse perinatal outcome was significantly associated with advanced maternal age (p = 0.002), obesity (p < 0.001), co-existing hypertensive disease (p < 0.001) and abnormal UA Doppler waveforms (p < 0.001). Fifty-seven infants were affected by 72 individual morbidities (figure 1), with the most frequent one being sepsis (36 cases), followed by NEC (11 cases) and IVH (7 cases). Five infants had BPD, 4 had PVL and a further 3 were diagnosed with HIE. Some infants were affected by more than one morbidity, for example an infant delivered at 26 + 6 weeks gestation weighing 680 grams was concomitantly affected by IVH, PVL, NEC and sepsis.
Conclusions: Adverse perinatal outcome in FGR infants is significantly associated with advanced maternal age, obesity and co-existing hypertensive disease. In addition, gestational age at delivery and abnormal UA Doppler contribute to morbidity outcomes.
Read More: http://informahealthcare.com/doi/full/10.3109/14767058.2014.924236