121. Neonatal outcome after natural course of preterm IUGR fetuses with abnormal umbilical Doppler flow in combination with preeclampsia

Abstract

Introduction The natural course of preterm IUGR pregnancies with absent or reversed end diastolic flow (AREDF) in the umbilical artery and preeclampsia has not been investigated so far. Objectives Determine neonatal outcome of preterm IUGR pregnancies with AREDF and preeclampsia after expectant obstetric management. Methods Patients were admitted between 2004 and 2014 in the Erasmus Medical Centre with preterm IUGR. Inclusion criteria: singletons, IUGR, 24–32 weeks, birth weight 500–1250 g. Admission was on clinical grounds and/or because of AREDF. Patients were allocated to the AREDF group or the normal end-diastolic flow (NEDF) group. After expectant management, pregnancies were terminated because of fetal distress or for maternal reasons. Short-term primary outcomes: idiopathic respiratory distress syndrome (IRDS), sepsis, bronchopulmonary dysplasia, necrotizing enterocolitis, intraventricular hemorrhage, composite neonatal outcome and perinatal mortality. Long-term primary outcome: cognitive and motor neurodevelopment at two years of age with Bayley III (BSID III). Results 433 women with preterm IUGR were admitted, 184 met the inclusion criteria, 33 were also diagnosed with preeclampsia. AREDF had no adverse effects on perinatal morbidity and mortality. NEDF seemed to increase the risk for IRDS (P = 0.021). Between the two groups, no differences were found on cognitive (P = 0.078) and motor development (P = 0.568). There were no differences in gestational age at delivery. Expectant management had positive effects on sepsis (P = 0.006) and perinatal mortality (P = 0.042). Delivery was postponed between 1 day and 10 weeks. Preeclampsia had no additional adverse effects on the prevalence of perinatal morbidity and mortality (P = 0.402) and cognitive and motor neurodevelopment (P = 0.611 and P = 0.640). Discussion No significant differences in neonatal outcome were found between the AREDF and NEDF group irrespective of co-existing preeclampsia after expectant management. It seems that postponing the delivery reduces perinatal morbidity and mortality. NEDF seemed to increase the risk of IRDS.