Outcome in early-onset fetal growth restriction is best combining computerized fetal heart rate analysis with ductus venosus Doppler: insights from the Trial of Umbilical and Fetal Flow in Europe

Frusca, T.; Todros, Tullia; Lees, C.; Bilardo, Caterina M.; Hecher, Kurt; Visser, Gerard H.A.; Papageorghiou, Aris T.; Marlow, Neil; Thilaganathan, B.; Wassenaer-Leemhuis, Aleid van; Maršál, Karel; Arabin, Birgit; Brezinka, Christoph; Derks, Jan; Diemert, Anke; Duvekot, Johannes J.; Ferrazzi, Enrico; Ganzevoort, Wessel; Martinelli, Pasquale; Ostermayer, E.; Schlembach, Dietmar; Valensise, H.; Thornton, Jim; Wolf, Hans

doi:10.1016/j.ajog.2017.12.226

Cited by 52 publications

(57 citation statements)

References 42 publications

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“…However, cases with a diagnosis of anomalous FGR proceeded to a later GA and had higher birth weight compared to cases of periviable FGR of presumed uteroplacental origin. This is explained in part by the different biology of the two conditions, with uteroplacental etiology being commonly associated with fetal Doppler abnormalities, which may indicate early delivery 4,5 , and in part by the higher incidence of hypertensive conditions in FGR of presumed uteroplacental origin, which we found in this cohort and is consistent with the etiology of early FGR of uteroplacental origin 2,4,5,7,8 . More specifically, in liveborn neonates with a genetic abnormality, death occurred almost invariably within 28 days after birth.…”

Section: Discussionsupporting

confidence: 66%

Etiology and perinatal outcome of periviable fetal growth restriction associated with structural or genetic anomaly

Dall’Asta

Girardelli

Usman

et al. 2020

Ultrasound in Obstet & Gyne

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Objective To investigate the etiology and perinatal outcome of periviable fetal growth restriction (FGR) associated with a structural defect or genetic anomaly. Methods This was a retrospective study of singleton pregnancies seen at a referral fetal medicine unit between 2005 and 2018, in which FGR (defined as fetal abdominal circumference ≤ 3rd percentile for gestational age) was diagnosed between 22 + 0 and 25 + 6 weeks of gestation. The study group included pregnancies with periviable FGR associated with a genetic or structural anomaly (anomalous FGR), while the control group consisted of structurally and genetically normal pregnancies with periviable FGR (non‐anomalous FGR). Results of genetic testing, TORCH screen and postmortem examination, as well as perinatal outcome, were investigated. Results Of 255 pregnancies complicated by periviable FGR, 188 were eligible; of which 52 (28%) had anomalous FGR and 136 (72%) had non‐anomalous FGR. A confirmed genetic abnormality accounted for 17/52 cases (33%) of anomalous FGR, with trisomy 18 constituting over 50% (9/17; 53%). The most common structural defects associated with FGR were central nervous system abnormalities (13/35; 37%). Overall, 12 (23%) cases of anomalous FGR survived the neonatal period. No differences were found in terms of perinatal survival between pregnancies with anomalous and those with non‐anomalous FGR. Conclusions Most pregnancies complicated by anomalous FGR were associated with a structural defect. The presence of an associated genetic defect was invariably lethal, while those with a structural defect, in the absence of a confirmed genetic abnormality, survived into infancy in over 90% of cases, with an overall one in three chance of perinatal survival. These data can be used for counseling prospective parents. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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Section: Discussionsupporting

confidence: 66%

Etiology and perinatal outcome of periviable fetal growth restriction associated with structural or genetic anomaly

Dall’Asta

Girardelli

Usman

et al. 2020

Ultrasound in Obstet & Gyne

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“…Several studies investigated the diagnostic value of ductus venosus blood flow in detection of fetuses with congenital heart disease, hypoxic or congestive fetal myocardial diseases both from a clinical and a scientific point of view. There is now a well-documented association between abnormal DV flow and complicated monochrionic multiple gestation, chromosomal anomalies, and adverse fetal outcome [1][2][3]14].…”

Section: Discussionmentioning

confidence: 99%

“…11 Gestational age-related reference intervals for DV PI estimated by the current study as contrasted with those obtained from previous studies depending on the equipment, sonologist experience, insonation techniques, angle correction, and positioning of the sample volume of pulsed Doppler in the DV. The strengths of this study are (1) the adequate sample size for each gestational week; (2) large numbers of observations, each case was examined at least three times; and (3) that we also included fetuses in the late first trimester and early second trimester [11][12][13][14][15][16][17][18][19], unlike most other studies. Moreover, inter-observer variations of the measurement are acceptable.…”

Section: Discussionmentioning

confidence: 99%

Reference values for ductus venosus flow in normal gestation among an Egyptian population

Zytoon

El-Abakawy²,

Hassanein

2020

Egypt J Radiol Nucl Med

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Background: Doppler studies of the fetal circulation have demonstrated the importance of the ductus venosus in the continuous monitoring of fetuses, especially those of high-risk pregnancies that can lead to abnormal pregnancy outcome. We tried to put reference values for the normal ductus venosus (DV) flow in normal gestation to be used in further studies assessing the different pathologies. Results: The DV length ranged from 9.8 to 20.9 mm, and the diameter ranged from 0.6 to 2.3 mm. The DV pulsatility index, resistive index, and systolic velocity/maximum velocity during atrial wave ratio declined linearly with increasing of gestational age and were increased after that during the last weeks of pregnancy. Ductus venosus S wave and A wave velocities increased linearly from a mean of 38.30 at the first trimester to 61.68 at the third trimester and from a mean of 11.38 at the first trimester to 30.71 at the third trimester respectively. Conclusion: A reference range of the normal ductus venosus different Doppler parameters was constructed in a centile module.

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“…Small‐for‐gestational‐age (SGA) pregnancies, in particular those with fetal growth restriction (FGR), are associated with an increased risk of adverse fetal, neonatal and longer term childhood outcomes. FGR is defined as estimated fetal weight (EFW) < 3 rd centile or impaired placental‐fetal blood flow, defined as uterine or umbilical artery pulsatility index (PI) > 95 th centile or absent end‐diastolic flow in the umbilical artery (< 32 weeks' gestation), or redistribution of fetal cerebral blood flow, defined as cerebroplacental ratio < 5 th centile (≥ 32 weeks' gestation).…”

Section: Introductionmentioning

confidence: 99%

Are maternal hemodynamic indices markers of fetal growth restriction in pregnancies with a small‐for‐gestational‐age fetus?

Perry

Lehmann

Mantovani

et al. 2020

Ultrasound in Obstet & Gyne

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Objective Pregnancies complicated by fetal growth restriction (FGR) have a worse outcome than those with a small‐for‐gestational‐age (SGA) fetus. There is increasing evidence of a maternal cardiovascular role in the pathophysiology of FGR. We aimed to compare maternal hemodynamic indices between pregnancies complicated by FGR and those delivering a SGA neonate, using a non‐invasive device. Methods This was a prospective study of normotensive pregnancies complicated by FGR (defined as estimated fetal weight (EFW) < 3rd centile or Doppler evidence of impaired placental‐fetal blood flow), those with a SGA fetus (defined as EFW < 10th centile) and control pregnancies with an appropriately grown fetus. Assessment of maternal hemodynamics (heart rate (HR), cardiac output (CO), mean arterial pressure (MAP), systemic vascular resistance (SVR) and stroke volume) was performed using a non‐invasive device (USCOM‐1A®). Uterine artery (UtA) pulsatility index (PI) was measured using transabdominal ultrasound. Hemodynamic variables that are affected by gestational age and maternal characteristics were corrected for using device‐specific reference ranges. Comparison between groups was performed using the chi‐square test or the Mann–Whitney U‐test, as appropriate. Results A total of 102 FGR, 64 SGA and 401 control pregnancies, with a median gestational age of 36 weeks, were included in the analysis. Women with a pregnancy complicated by FGR and those with a SGA fetus were shorter and weighed less than did controls. Compared with controls, the FGR group had significantly lower median maternal HR (80 beats per min (bpm) vs 85 bpm; P = 0.001) and CO multiples of the median (MoM; 0.91 vs 0.98; P = 0.003), and higher median maternal MAP (90 mmHg vs 87 mmHg; P = 0.040), SVR MoM (1.2 vs 1.0; P < 0.001) and UtA‐PI MoM (1.1 vs 0.96; P < 0.001), but there was no significant difference in stroke volume MoM (1.0 vs 0.98; P = 0.647). Compared with the SGA group, the FGR group had a significantly lower median HR (80 bpm vs 87 bpm; P = 0.022), and higher median maternal MAP (90 mmHg vs 85 mmHg; P = 0.025), SVR MoM (1.2 vs 1.0; P = 0.002) and UtA‐PI MoM (1.1 vs 0.98; P = 0.005), but there was no significant difference in CO MoM (0.91 vs 0.96; P = 0.092) or stroke volume MoM (1.0 vs 1.0; P = 0.806). There were no significant differences in adjusted maternal hemodynamic indices between the SGA group and controls. Conclusion Pregnancies complicated by FGR presented with impaired maternal hemodynamic function, as evidenced by lower HR and CO, as well as higher MAP, SVR and UtA resistance. Pregnancies delivering a SGA neonate, without evidence of FGR, had normal maternal hemodynamic function. Maternal hemodynamic indices may therefore be of value in distinguishing FGR from SGA pregnancies. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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Outcome in early-onset fetal growth restriction is best combining computerized fetal heart rate analysis with ductus venosus Doppler: insights from the Trial of Umbilical and Fetal Flow in Europe

Cited by 52 publications

References 42 publications

Etiology and perinatal outcome of periviable fetal growth restriction associated with structural or genetic anomaly

Etiology and perinatal outcome of periviable fetal growth restriction associated with structural or genetic anomaly

Reference values for ductus venosus flow in normal gestation among an Egyptian population

Are maternal hemodynamic indices markers of fetal growth restriction in pregnancies with a small‐for‐gestational‐age fetus?

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