P05.04: Timing of delivery in pregnancies with extremely preterm growth restricted fetuses

Abstract

To evaluate the outcome of growth restricted fetuses delivered in very early pregnancy because of severely abnormal Doppler velocimetry. In a study during 1998–2002 we evaluated antenatal surveillance and outcome for 32 IUGR fetuses with abnormal blood flow examinations delivered between 24 + 0 and 29 + 6 gestational weeks at the Department of Obstetrics and Gynecology, University Hospital of Lund. The hospital is referral centre for the southern region of Sweden with a population of approximately 2.5 million. The decision to deliver on fetal indication was based on parental approval, knowledge of the rate of survival and of morbidity at the NICU at our hospital and of the deterioration of blood flow and in some cases with concomitant fetal heart rate changes. One hundred and fourteen gestational age matched newborns delivered for other reasons than blood flow changes were used as controls. All the fetuses in the study group showed severe blood flow changes in the umbilical artery with absent or reversed diastolic flow. They were initially followed with serial examinations when deteriorating blood flow. A combined evaluation of umbilical artery flow velocimetry with cerebral and central venous blood flow studies was done and FHR monitoring was done individually 2–4 times daily. There was an increased incidence of NEC in the IUGR group, but there was no increase in perinatal mortality or major cerebral morbidity compared with controls. All 32 IUGR newborns survived until discharge from the NICU. The survival at 1 year of age was 94%. The results from the study indicate that the integration of surveillance methods is beneficial for the sick extremely preterm fetuses. With our present knowledge optimal timing for delivery seems to be when severe umbilical artery Doppler blood flow changes coincides with deterioration of central venous fetal blood flow, especially in the ductus venosus.