Early Onset Severe IUGR: Waiting to Deliver Does Not Appear to Improve Outcome and May Be Harmful [35R

Abstract

INTRODUCTION: Preterm delivery of IUGR fetuses prior to 32 wks is rarely indicated, occurring in < 1.9% of all pregnancies. We sought to determine if delaying delivery until non-reassuring fetal heart tracing (NRFT) increases adverse outcomes. METHODS: In a cohort of IUGR < 32 wks, two groups were compared: those delivered for abnormal UAD studies and those delivered for NRFT. Fetuses with persistent absent (AEDF) or reversed end diastolic flow (REDF) were placed on continuous monitoring until delivery. Pregnancies were excluded when delivered for maternal deterioration. T-test and Chi-square were performed where appropriate. RESULTS: 43 singletons with IUGR < 32 weeks gestation and abnormal UAD from 2012-2015. Mean GA at diagnosis 24.7 +/-3.1 wks (range 18-30.3 wks). 30 delivered for abnormal UAD and 13 for NRFT. Pregnancy characteristics were similar between groups. Women progressing to urgent delivery due to NRFT were more likely to undergo cesarean (CD) than SVD (p=0.01). 83.9% of both groups were delivered via CD and were significantly smaller compared to those able to be born via SVD (p=0.026). Women with HTN, preeclampsia or GHTN were also more likely to undergo CD than SVD (p=0.04). Expectant management until NRFT of abnormal UAD did not decrease requirement for CPR at delivery or incidence of IVH, RDS, or death. Length of stay was 50.9 days in those delivered for Doppler while 61.2 days in the group delivered emergently (p=0.23). CONCLUSION: Waiting to deliver until there was NRFT does not appear to decrease neonatal morbidity/mortality, increases risk for emergency CD, and may increase length of stay in NICU.