Severe fetal growth restriction at 26–32 weeks: key messages from the TRUFFLE study

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

“…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, 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. More specifically, in liveborn neonates with a genetic abnormality, death occurred almost invariably within 28 days after birth.…”

“…According to the most widely accepted definition, early FGR is diagnosed when the criteria for impaired fetal growth are met before a gestational age (GA) cut‐off of 32 weeks. Recent evidence has shown that the short‐term and 2‐year outcomes of growth‐restricted fetuses from singleton pregnancies, diagnosed between 26 and 32 weeks' gestation, are unexpectedly good, with an overall mortality rate of 8% and rate of survival without impairment of 82%. More recently, two retrospective studies have also reported high survival rates for non‐anomalous growth‐restricted fetuses diagnosed at a periviable GA between 22 and 26 weeks and at a previable GA between 17 and 22 weeks, albeit using different criteria to define fetal smallness.…”

Predictors of perinatal outcome in early‐onset fetal growth restriction: A study from an emerging economy country

“…The fact that UA Doppler was more predictive of morbidity and of the composite poor outcome than DV flow after inclusion of the EFW z‐score agrees with the findings in other studies. Possible reasons include the following: First, fetal hypoxic injuries may vary in the target organs most affected and timing of deterioration, which is why the combination of different fetal parameters continues to be the best model at this point. The authors of the TRUFFLE study emphasized that despite the fact that absent/reversed DV a‐wave velocity has been considered the best predictor of normal infant neurodevelopment in severe IUGR, its use in clinical practice should be correlated with other biophysical variables, mostly using computerized cardiotocography (cCTG).…”

Ultrasound fetal weight estimation at term may do more harm than good

“…The recent DELPHI consensus on FGR provides clinical guidance for the identification of early-onset FGR 10 . The concomitant publication of the TRUFFLE series data provides robust evidence that early-onset FGR requires monitoring with both computerized cardiotocography/non-stress test as well as ductus venosus Doppler assessment 11 . The TRUFFLE data provide a pragmatic framework for monitoring and thresholds for scheduling birth -both related to excellent clinical outcomes with > 90% intact survival in this high-risk, very preterm FGR cohort.…”