416 Relationship between reduced fetal growth velocity and adverse perinatal outcome

Abstract

Listen

Translate article

Introduction: According to the Delphi consensus late FGR, is among other defined as reduced growth velocity over 2 quartiles combined with abnormal CPR and/or increased PI in umbilical artery. It has been hypothesized that AGA neonates with reduced growth velocity in utero may be at higher risk of adverse perinatal outcome. Aim of the study: Assessment of the incidence of reduced growth velocity (RGV) and its relationship with adverse perinatal outcome. Methods: This is a retrospective cohort study. An anonymized database of singleton deliveries was created by combining the Astraia ultrasound database and the hospital electronic medical records. The study included singleton deliveries with an ultrasound in 28-32 weeks of gestation and subsequently delivered at our maternity unit. Exclusion criteria were major congenital anomalies, abnormal karyotype, multiple deliveries, and LGA neonates. Retrospectively based on the biometric measurements the Intergrowth centile was calculated. FGR was defined as below the 3rd centile, SGA as between the 3-10 centile, AGA as between the 10-90th centile, LGA as above the 90th centile. The birthweight centile was calculated using the Intergrowth chart. RGV was defined as decrease by at least 50 centile between birthweight and estimated fetal weight on ultrasound at 28-32 scan. Composite neonatal outcome, intrauterine fetal death and neonatal death were assessed in the following groups: SGA, AGA+RGV, SGA+RGV and AGA. A subgroup of FGR (weight < 3 centile) was analyzed. Adverse neonatal outcomes were defined as CS for fetal distress, instrumental vaginal delivery for fetal distress, respiratory distress syndrome, intraventricular haemorrhage grade III or IV, neonatal sepsis, periventricular leukomalacia, confirmed seizures and Apgar Score < 8 at 5 minutes of observation. APO was defined as combination of IUFD, ND+CNO. Results: The final database of combined ultrasound and delivery records comprised of 1906 records (AGA n=1748, AGA+RGV n=25, SGA n=126, SGA+RGV n=7 and FGR n=36; 91.71%, 1,31%, 6.61%, 0.37%, 2.41% respectively). The highest risk of APO was in neonates with FGR, birthweight below 3rd centile and was 73.91%, followed by SGA 57.94%. SGA with RGV had lower risk of APO 14.29%. This may be a selection bias because these pregnancies were monitored at our outpatient clinic. There were no differences in APO between AGA and AGA with RGV. Conclusions: The role of RGV needs further assessment. We confirmed the high risk of APO in relation to birthweight below the 3rd centile. RGV prompts increased surveillance in pregnancies at risk of SGA. This may explain the reduced risk of adverse perinatal outcome in this group.