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Early intervention in management of very preterm growth-restricted fetuses : 2-year outcome of infants delivered on fetal indication before 30 gestational weeks

Brodszki, Jana LU ; Morsing, Eva LU ; Malcus, Peter LU ; Thuring, Ann LU ; Ley, David LU and Marsal, Karel LU (2009) In Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 34(3). p.288-296
Abstract

OBJECTIVES: To describe the outcome of growth-restricted fetuses with absent or reversed end-diastolic flow (ARED) in the umbilical artery delivered on fetal indication before 30 gestational weeks.

METHODS: Between 1998 and 2004, 42 fetuses with intrauterine growth restriction (IUGR) and ARED in the umbilical artery were delivered liveborn by Cesarean section on fetal indication before 30 gestational weeks. The median gestational age at delivery was 27 + 1 (range, 24 + 4 to 29 + 5) weeks. An additional four fetuses died in utero at a median gestational age of 24 + 2 (range, 23 + 5 to 25 + 4) weeks. Neonatal morbidity, infant mortality and major neurological morbidity of liveborn infants were compared with those in two control... (More)

OBJECTIVES: To describe the outcome of growth-restricted fetuses with absent or reversed end-diastolic flow (ARED) in the umbilical artery delivered on fetal indication before 30 gestational weeks.

METHODS: Between 1998 and 2004, 42 fetuses with intrauterine growth restriction (IUGR) and ARED in the umbilical artery were delivered liveborn by Cesarean section on fetal indication before 30 gestational weeks. The median gestational age at delivery was 27 + 1 (range, 24 + 4 to 29 + 5) weeks. An additional four fetuses died in utero at a median gestational age of 24 + 2 (range, 23 + 5 to 25 + 4) weeks. Neonatal morbidity, infant mortality and major neurological morbidity of liveborn infants were compared with those in two control groups: all 371 liveborn infants delivered at < 30 weeks during the corresponding time period (Group A) and a subset of these, 42 matched infants without IUGR (Group B).

RESULTS: Thirty-two fetuses (76%) [corrected] were delivered within 48 h of the occurrence of ARED (25 absent, seven reversed end-diastolic flow). The remaining 10 fetuses (five absent, five reversed end-diastolic flow) were monitored for a median of 6.5 (range, 3-18) days before delivery. One infant died in the neonatal period and three during the first year of postnatal life (2-year survival 90%). The incidence of chronic lung disease was higher in the ARED Group than in Control Groups A and B (P = 0.001 and P = 0.03, respectively). There were no differences between the groups in the occurrence of necrotizing enterocolitis, cerebral hemorrhage or retinopathy of prematurity. Cerebral palsy was diagnosed in 14% of the index group compared with 11% and 17% of Control Groups A and B (P > 0.05).

CONCLUSIONS: Very preterm growth-restricted fetuses with umbilical artery ARED delivered on fetal indication, in most cases before the occurrence of severe changes in the ductus venosus velocity waveforms and/or fetal heart rate tracings, showed high 2-year survival and low morbidity.

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published
subject
keywords
Adult, Blood Flow Velocity/physiology, Female, Fetal Growth Retardation/diagnostic imaging, Fetal Heart/diagnostic imaging, Gestational Age, Humans, Infant, Infant, Newborn, Infant, Premature, Infant, Small for Gestational Age, Male, Pregnancy, Retrospective Studies, Ultrasonography, Prenatal, Umbilical Arteries/diagnostic imaging, Young Adult
in
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
volume
34
issue
3
pages
9 pages
publisher
John Wiley & Sons Inc.
external identifiers
  • wos:000269867500009
  • pmid:19705404
  • scopus:69949089677
  • pmid:19705404
ISSN
1469-0705
DOI
10.1002/uog.7321
language
English
LU publication?
yes
id
1e94a625-3f55-4bc8-9e8d-56f4aa4367af (old id 1469384)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/19705404?dopt=Abstract
date added to LUP
2016-04-04 09:09:13
date last changed
2021-08-04 01:38:04
@article{1e94a625-3f55-4bc8-9e8d-56f4aa4367af,
  abstract     = {<p>OBJECTIVES: To describe the outcome of growth-restricted fetuses with absent or reversed end-diastolic flow (ARED) in the umbilical artery delivered on fetal indication before 30 gestational weeks.</p><p>METHODS: Between 1998 and 2004, 42 fetuses with intrauterine growth restriction (IUGR) and ARED in the umbilical artery were delivered liveborn by Cesarean section on fetal indication before 30 gestational weeks. The median gestational age at delivery was 27 + 1 (range, 24 + 4 to 29 + 5) weeks. An additional four fetuses died in utero at a median gestational age of 24 + 2 (range, 23 + 5 to 25 + 4) weeks. Neonatal morbidity, infant mortality and major neurological morbidity of liveborn infants were compared with those in two control groups: all 371 liveborn infants delivered at &lt; 30 weeks during the corresponding time period (Group A) and a subset of these, 42 matched infants without IUGR (Group B).</p><p>RESULTS: Thirty-two fetuses (76%) [corrected] were delivered within 48 h of the occurrence of ARED (25 absent, seven reversed end-diastolic flow). The remaining 10 fetuses (five absent, five reversed end-diastolic flow) were monitored for a median of 6.5 (range, 3-18) days before delivery. One infant died in the neonatal period and three during the first year of postnatal life (2-year survival 90%). The incidence of chronic lung disease was higher in the ARED Group than in Control Groups A and B (P = 0.001 and P = 0.03, respectively). There were no differences between the groups in the occurrence of necrotizing enterocolitis, cerebral hemorrhage or retinopathy of prematurity. Cerebral palsy was diagnosed in 14% of the index group compared with 11% and 17% of Control Groups A and B (P &gt; 0.05).</p><p>CONCLUSIONS: Very preterm growth-restricted fetuses with umbilical artery ARED delivered on fetal indication, in most cases before the occurrence of severe changes in the ductus venosus velocity waveforms and/or fetal heart rate tracings, showed high 2-year survival and low morbidity.</p>},
  author       = {Brodszki, Jana and Morsing, Eva and Malcus, Peter and Thuring, Ann and Ley, David and Marsal, Karel},
  issn         = {1469-0705},
  language     = {eng},
  number       = {3},
  pages        = {288--296},
  publisher    = {John Wiley & Sons Inc.},
  series       = {Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology},
  title        = {Early intervention in management of very preterm growth-restricted fetuses : 2-year outcome of infants delivered on fetal indication before 30 gestational weeks},
  url          = {http://dx.doi.org/10.1002/uog.7321},
  doi          = {10.1002/uog.7321},
  volume       = {34},
  year         = {2009},
}