Timing Delivery of the Growth-Restricted Fetus

Galan, Henry L.

doi:10.1053/j.semperi.2011.05.009

Cited by 88 publications

(11 citation statements)

References 83 publications

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“…Current management in FGR is designed to avoid stillbirth, incidence 1.1–3.6%, and deliver the most mature baby as possible [6, 7]. Up to 70% of fetuses with suspected FGR may be constitutionally small normal infants and may not be at increased risk for stillbirth, and the remainder (after exclusion of birth defects, congenital infections, and chromosomal abnormalities) will have FGR presumably related to a pathologic placental process [5, 8]. …”

Section: Introductionmentioning

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

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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.

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Section: Introductionmentioning

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

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“…Differential diagnosis between fetuses that are small due to 'placental intrauterine growth restriction' and those that are 'constitutionally small fetuses' has been considered a major area of interest in clinical obstetrics (11)(12)(13)(14)(15). The important preliminary step would be to determine PE coexistence.…”

Section: Discussionmentioning

confidence: 99%

Prenatal sFlt-1/PlGF value for prediction of adverse neonatal outcome of isolated ultrasonic small-for-gestational-age fetus in normotensive pregnant women: A prospective cohort study

Shim

Jeon

Ryu

et al. 2019

Preprint

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Background: Not only preeclampsia but also small-for-gestational-age (SGA) neonates in the absence of preeclampsia are at increased risk of morbidity and mortality. Early recognition of fetuses at increased risk of being growth-restricted enables more appropriate surveillance and optimization of management for reduced risk of adverse neonatal outcomes. We investigated potential value of soluble fms-like tyrosine kinase-1 (sFlt-1) to placental growth factor (PlGF) ratio, estimated in late-second and early-third trimester respectively, for prediction of SGA neonates with poor neonatal outcome in the absence of preeclampsia. Methods: Included in this case control study were 530 singleton pregnant women who had attended the prenatal screening program at single institution between January 2011 and March 2012. Demographic and clinical information of maternal and neonatal data were collected. The sFlt-1/ PlGF value at 24 to 28+6 weeks and 29 to 36+6 weeks of gestation were analyzed for comparing appropriate for gestational age control group, SGA and SGA with poor neonatal group. Results: After excluding 22 preeclampsia cases, 47 SGA group and 461 control-group were included. Among SGA group, 17 neonates had adverse neonatal outcome (36.1%, 17/47). Mean gestational age at delivery in SGA group was 37.76±2.05 weeks, which showed no significant difference comparing to control group (38.43±2.1 weeks, p=0.122). The sFlt-1/PlGF ratios at late-second trimester were both higher in the SGA group and poor neonatal SGA group than control group (3.74±2.52 vs 6.73±8.22 vs 7.62±15.2, p=0.63) and especially sFlt-1/PlGF ratio at early-third trimester was significantly higher (14.41±12.5 vs 28.62±37.2 vs 109.12±83.96, p=0.002). As gestational age advances, rapid increase in sflt-1/PlGF ratio detected in poor SGA group comparing to SGA group with no adverse outcome. A cutoff value of 28.15 for the sFlt-1/PlGF ratio at 29 to 36+6weeks significantly predicted SGA neonates who had adverse outcome, with sensitivity and specificity of 76.9% and 88%, respectively. Conclusion: In this study, sFlt-1/PlGF ratio of SGA with adverse neonatal outcome group was significantly higher than control group. This study suggests the feasibility of the sFlt-1/PlGF ratio as helpful objective measurement for predicting the adverse SGA neonatal outcome by providing sFlt-1/PlGF cutoff value, besides ultrasound biometry measurement.

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“…Biophysical profile is generally used to evaluate hypoxemia‐related changes . Biophysical profile is subjective and its clinical utility is limited.…”

Section: Discussionmentioning

confidence: 99%

Amniotic fluid erythropoietin and neonatal outcome in pregnancies complicated by intrauterine growth restriction before 34 gestational weeks

Seikku

Rahkonen

Tikkanen

et al. 2015

Acta Obstet Gynecol Scand

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High amniotic fluid erythropoietin concentrations are associated with decreased umbilical artery pH and base excess and with adverse neonatal outcome in pregnancies complicated by intrauterine growth restriction before 34 gestational weeks. In selected pregnancies complicated by intrauterine growth restriction, determining amniotic fluid erythropoietin could be a useful additional tool in fetal surveillance and possibly in optimizing timing of delivery.

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Timing Delivery of the Growth-Restricted Fetus

Cited by 88 publications

References 83 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

Prenatal sFlt-1/PlGF value for prediction of adverse neonatal outcome of isolated ultrasonic small-for-gestational-age fetus in normotensive pregnant women: A prospective cohort study

Amniotic fluid erythropoietin and neonatal outcome in pregnancies complicated by intrauterine growth restriction before 34 gestational weeks

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