Neonatal morbidity after induction vs expectant monitoring in intrauterine growth restriction at term: a subanalysis of the DIGITAT RCT

Boers, Kim E.; Wyk, Linda van; Post, Joris A. M. van der; Kwee, Anneke; Pampus, Maria G. van; Spaanderdam, Marc E.A.; Duvekot, Johannes J.; Bremer, Henk A.; Delemarre, Friso M.C.; Bloemenkamp, Kitty W. M.; Groot, Christianne de; Willekes, Christine; Rijken, Monique; Roumen, Frans J.M.E.; Thornton, Jim; Lith, J. M. M. van; Mol, Ben W J; Cessie, Saskia le; Scherjon, Sicco A.

doi:10.1016/j.ajog.2012.01.015

Cited by 67 publications

(40 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This rate of morbidity appears high and brings up questions regarding the ideal gestational age for delivery in late-onset FGR. The Disproportionate Intrauterine Growth Intervention Trial at Term showed lower neonatal intensive care unit admissions after 38 weeks in comparison to 36 to 37 weeks [31]. …”

Section: Discussionmentioning

confidence: 99%

Suspected Fetal Growth Restriction at 37 Weeks: A Comparison of Doppler and Placental Pathology

Curtin

Millington

Ibekwe

et al. 2017

BioMed Research International

View full text Add to dashboard Cite

Objective. Our objective was determining if abnormal Doppler evaluation had a higher prevalence of placental pathology compared to normal Doppler in suspected fetal growth restriction (FGR) of cases delivered at 37 weeks. Study Design. This retrospective cohort study of suspected FGR singletons with antenatal Doppler evaluation delivered at 37 weeks had a primary outcome of the prevalence of placental pathology related to FGR. Significance was defined as p ≤ 0.05. Results. Of 100 pregnancies 46 and 54 were in the abnormal and normal Doppler cohorts, respectively. Placental pathology was more prevalent with any abnormal Doppler, 84.8% versus 55.6%, odds ratio (OR) 4.46, 95% confidence interval (CI): 1.55, 13.22, and p = 0.002. Abnormal middle cerebral artery (MCA) Doppler had a higher prevalence: 96.2% versus 54.8%, OR 20.7, 95% CI: 2.54, 447.1, and p < 0.001. Conclusion. Abnormal Doppler was associated with more placental pathology in comparison to normal Doppler in fetuses with suspected FGR. Abnormal MCA Doppler had the strongest association.

show abstract

Section: Discussionmentioning

confidence: 99%

Suspected Fetal Growth Restriction at 37 Weeks: A Comparison of Doppler and Placental Pathology

Curtin

Millington

Ibekwe

et al. 2017

BioMed Research International

View full text Add to dashboard Cite

show abstract

“…MCA is particularly valuable for the identification [8] and prediction [42,43] of adverse outcome among late-onset FGR, independently of the UA Doppler, which is often normal in these fetuses. Fetuses with abnormal MCA PI had a sixfold risk of emergency cesarean section for fetal distress when compared with SGA fetuses with normal MCA PI [44], which is particularly relevant because labor induction at term is the current standard of care of late-onset FGR [45,46]. Late FGRs with abnormal MCA PI have poorer neurobehavioral competence at birth and at 2 years of age [42,47].…”

Section: Clinical Management Of Fetal Growth Restriction and Small-fomentioning

confidence: 99%

“…They found negligible differences in peri- and neonatal outcomes between induction of labor and expectant monitoring [45,46]. At 2 years of age, about half of the cohort were evaluated for neurodevelopmental and neurobehavioral assessment, with no differences between both strategies [82].…”

Section: Clinical Management Of Fetal Growth Restriction and Small-fomentioning

confidence: 99%

Update on the Diagnosis and Classification of Fetal Growth Restriction and Proposal of a Stage-Based Management Protocol

Figueras

Gratacós²

2014

Fetal Diagn Ther

599

672

View full text Add to dashboard Cite

Small fetuses are defined as those with an ultrasound estimated weight below a threshold, most commonly the 10th centile. The first clinically relevant step is the distinction of ‘true' fetal growth restriction (FGR), associated with signs of abnormal fetoplacental function and poorer perinatal outcome, from constitutional small-for-gestational age, with a near-normal perinatal outcome. Nowadays such a distinction should not be based solely on umbilical artery Doppler, since this index detects only early-onset severe forms. FGR should be diagnosed in the presence of any of the factors associated with a poorer perinatal outcome, including Doppler cerebroplacental ratio, uterine artery Doppler, a growth centile below the 3rd centile, and, possibly in the near future, maternal angiogenic factors. Once the diagnosis is established, differentiating into early- and late-onset FGR is useful mainly for research purposes, because it distinguishes two clear phenotypes with differences in severity, association with preeclampsia, and the natural history of fetal deterioration. As a second clinically relevant step, management of FGR and the decision to deliver aims at an optimal balance between minimizing fetal injury or death versus the risks of iatrogenic preterm delivery. We propose a protocol that integrates current evidence to classify stages of fetal deterioration and establishes follow-up intervals and optimal delivery timings, which may facilitate decisions and reduce practice variability in this complex clinical condition.

show abstract

“…The Disproportionate Intrauterine Growth Intervention Study at Term (DIGITAT) 2 showed that among women with suspected intrauterine growth restriction at 36 to 41 weeks, a policy of labor induction affects neither the rate of adverse neonatal outcomes nor the rates of instrumental vaginal delivery or caesarean section, indicating that both approaches are acceptable. The consensus view from the DIGITAT is that the optimum time for induction in SGA with normal Doppler study is at around 38 weeks, because it is associated with the lowest neonatal morbidity 63 and seems to minimize the risk of stillbirth. 64 Between 24 and 34 weeks, antenatal corticosteroids should be administered over a period of 48 hours for fetal lung maturity if delivery is being considered.…”

Section: To 38 Weeks Gestationmentioning

confidence: 99%

A Uniform Management Approach to Optimize Outcome in Fetal Growth Restriction

Seravalli

Baschat

2015

Obstetrics and Gynecology Clinics of North America

View full text Add to dashboard Cite

Neonatal morbidity after induction vs expectant monitoring in intrauterine growth restriction at term: a subanalysis of the DIGITAT RCT

Cited by 67 publications

References 25 publications

Suspected Fetal Growth Restriction at 37 Weeks: A Comparison of Doppler and Placental Pathology

Suspected Fetal Growth Restriction at 37 Weeks: A Comparison of Doppler and Placental Pathology

Update on the Diagnosis and Classification of Fetal Growth Restriction and Proposal of a Stage-Based Management Protocol

A Uniform Management Approach to Optimize Outcome in Fetal Growth Restriction

Contact Info

Product

Resources

About