Vicky O'Dwyer1, Gerard Burke2, Julia Unterscheider3, Sean Daly4, Michael P Geary5, Mairead M Kennelly6, Fionnuala M McAuliffe7, Keelin O'Donoghue8, Alyson Hunter9, John J Morrison10, Patrick Dicker11, Elizabeth C Tully3, Fergal D Malone3. 1. Department of Obstetrics and Gynecology, Royal College of Surgeons in Ireland, Dublin, Ireland. Electronic address: vickyodwyer@rcsi.ie. 2. Department of Obstetrics and Gynecology, Graduate Entry Medical School, University of Limerick, Limerick, Ireland. 3. Department of Obstetrics and Gynecology, Royal College of Surgeons in Ireland, Dublin, Ireland. 4. Department of Obstetrics and Gynecology, Coombe Women and Infants University Hospital, Dublin, Ireland. 5. Department of Obstetrics and Gynecology, Rotunda Hospital, Dublin, Ireland. 6. University College Dublin Center for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland. 7. Department of Obstetrics and Gynecology, University College Dublin School of Medicine and Medical Science, National Maternity Hospital, Dublin, Ireland. 8. Department of Obstetrics and Gynecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland. 9. Department of Obstetrics and Gynecology, Royal Jubilee Maternity Hospital, Belfast, Ireland. 10. Department of Obstetrics and Gynecology, National University of Ireland, Galway, Ireland. 11. Department of Epidemiology and Public Health, Royal College of Surgeons in Ireland, Dublin, Ireland.
Abstract
OBJECTIVE: We sought to determine the cause of adverse perinatal outcome in fetal growth restriction (FGR) where umbilical artery (UA) Doppler was normal, as identified from the Prospective Observational Trial to Optimize Pediatric Health (PORTO). We compared cases of adverse outcome where UA Doppler was normal and abnormal. STUDY DESIGN: The PORTO study was a national multicenter study of >1100 ultrasound-dated singleton pregnancies with an estimated fetal weight <10th centile. Each pregnancy underwent intensive ultrasound, including multivessel Doppler. UA Doppler was considered abnormal when the pulsatility index was >95th centile or end-diastolic flow was absent/reversed. Adverse perinatal outcome was defined as a composite of intraventricular hemorrhage, periventricular leukomalacia, hypoxic ischemic encephalopathy, necrotizing enterocolitis, bronchopulmonary dysplasia, sepsis, or death. RESULTS: In all, 57 (5.0%) of the 1116 fetuses had an adverse perinatal outcome. Nine (1.3%) of 698 fetuses with normal UA Doppler had an adverse outcome, compared with 48 (11.5%) of 418 with abnormal UA Doppler (P < .0001). There were 2 perinatal deaths in the normal group and 6 in the abnormal group (P = .01). The perinatal deaths in the normal group were 1 case of pulmonary hypoplasia after prolonged preterm rupture of the membranes from 12 weeks' gestation and a case of placental abruption. Gestation at delivery was 33 ± 3 vs 31 ± 4 weeks (P = .05) and mean birthweight was 1830 ± 737 vs 1146 ± 508 g (P = .001) in the respective groups. Neonatal sepsis was the commonest adverse outcome in both groups: 0.1% and 0.4%, respectively (P = .01). CONCLUSION: Adverse perinatal outcome is uncommon in FGR with normal UA Doppler. The cases we identified were associated with heterogenous pathologies. FGR with normal UA blood flow is a largely benign condition.
OBJECTIVE: We sought to determine the cause of adverse perinatal outcome in fetal growth restriction (FGR) where umbilical artery (UA) Doppler was normal, as identified from the Prospective Observational Trial to Optimize Pediatric Health (PORTO). We compared cases of adverse outcome where UA Doppler was normal and abnormal. STUDY DESIGN: The PORTO study was a national multicenter study of >1100 ultrasound-dated singleton pregnancies with an estimated fetal weight <10th centile. Each pregnancy underwent intensive ultrasound, including multivessel Doppler. UA Doppler was considered abnormal when the pulsatility index was >95th centile or end-diastolic flow was absent/reversed. Adverse perinatal outcome was defined as a composite of intraventricular hemorrhage, periventricular leukomalacia, hypoxic ischemicencephalopathy, necrotizing enterocolitis, bronchopulmonary dysplasia, sepsis, or death. RESULTS: In all, 57 (5.0%) of the 1116 fetuses had an adverse perinatal outcome. Nine (1.3%) of 698 fetuses with normal UA Doppler had an adverse outcome, compared with 48 (11.5%) of 418 with abnormal UA Doppler (P < .0001). There were 2 perinatal deaths in the normal group and 6 in the abnormal group (P = .01). The perinatal deaths in the normal group were 1 case of pulmonary hypoplasia after prolonged preterm rupture of the membranes from 12 weeks' gestation and a case of placental abruption. Gestation at delivery was 33 ± 3 vs 31 ± 4 weeks (P = .05) and mean birthweight was 1830 ± 737 vs 1146 ± 508 g (P = .001) in the respective groups. Neonatal sepsis was the commonest adverse outcome in both groups: 0.1% and 0.4%, respectively (P = .01). CONCLUSION: Adverse perinatal outcome is uncommon in FGR with normal UA Doppler. The cases we identified were associated with heterogenous pathologies. FGR with normal UA blood flow is a largely benign condition.
Authors: Matthias C Schabel; Victoria H J Roberts; Karen J Gibbins; Monica Rincon; Jessica E Gaffney; Aaron D Streblow; Adam M Wright; Jamie O Lo; Byung Park; Christopher D Kroenke; Kathryn Szczotka; Nathan R Blue; Jessica M Page; Kathy Harvey; Michael W Varner; Robert M Silver; Antonio E Frias Journal: PLoS One Date: 2022-07-19 Impact factor: 3.752
Authors: Sarah Rae Easter; Linda O Eckert; Nansi Boghossian; Rebecca Spencer; Eugene Oteng-Ntim; Christos Ioannou; Manasi Patwardhan; Margo S Harrison; Asma Khalil; Michael Gravett; Robert Goldenberg; Alastair McKelvey; Manish Gupta; Vitali Pool; Stephen C Robson; Jyoti Joshi; Sonali Kochhar; Tom McElrath Journal: Vaccine Date: 2017-12-04 Impact factor: 3.641