Fetal Growth Rate Research Articles

The late preterm IUGR and/or SGA

It is well known that in late preterm infants the mortality and the morbidity are higher than in term neonates. The rate of complications decreases with the progression of gestational age through the late preterm period [1]. Intrauterine growth restriction (IUGR) is one of the cause for late preterm delivery and it occurs more often in late preterm infants than terms ones. Itself constitutes a risk factor for morbidity and mortality [2,3]. IUGR, as well as associated peri-natal morbidities, contributes to increase the risk, in these infants, of postnatal growth impairment, metabolic diseases and poor neuro-developmental outcome [1,4]. Late preterm small for gestational age (SGA) infants were 44 times more likely to die in the first month and 22 times more likely to die in their first year than term adequate for gestational age (AGA) newborns. This increased risk cannot be fully explained by an increasing prevalence of lethal congenital conditions among SGA late preterm newborns [5]. The ability to recognize abnormal growth at birth and or a intrauterine malnutrition is of great importance for the care and the prognosis of these neonates. Neonatal anthropometric charts are commonly used for the diagnosis at birth of SGA newborns [6]. The terms SGA and IUGR are often used as synonyms, however they reflect two different concepts. SGA refers to a statistical definition, based on an auxological cross-sectional evaluation (prenatal or neonatal), and denotes a fetus or a neonate whose anthropometric variables (usually weight) are lower than a given threshold value computed on a set of infants having the same gestational age. IUGR instead refers to a clinical and functional condition and denotes fetuses unable to achieve their own growth potential. Such a condition can be assessed by ultrasonography during pregnancy by a longitudinal evaluation of fetal growth rate. The current gold standard in neonatal auxological evaluation is based on informations obtained from both neonatal anthropometric charts and intrauterine growth charts [7]. At present specific growth charts to monitor postnatal growth of late preterm infants are not available. In the next future the late preterm postnatal longitudinal growth standards will be available as a result of “Intergrowth21st Project”.

Fetal growth and neurobehavioral outcomes in childhood

Using a sample of sibling pairs from a nationally representative U.S. survey, we examine the effects of the fetal growth rate on a set of neurobehavioral outcomes in childhood measured by parent-reported diagnosed developmental disabilities and behavior problems. Based on models that include mother fixed effects, we find that the fetal growth rate, a marker for the fetal environment, is negatively associated with lifetime diagnosis of developmental delay. We also find that the fetal growth rate is negatively associated with disruptive behaviors among male children. These results suggest that developmental disabilities and problem behaviors may play a role in explaining the well-documented association between birth weight and human capital outcomes measured in adulthood.

Maternal–Fetal Nutrient Transport in Pregnancy Pathologies: The Role of the Placenta

Appropriate in utero growth is essential for offspring development and is a critical contributor to long-term health. Fetal growth is largely dictated by the availability of nutrients in maternal circulation and the ability of these nutrients to be transported into fetal circulation via the placenta. Substrate flux across placental gradients is dependent on the accessibility and activity of nutrient-specific transporters. Changes in the expression and activity of these transporters is implicated in cases of restricted and excessive fetal growth, and may represent a control mechanism by which fetal growth rate attempts to match availability of nutrients in maternal circulation. This review provides an overview of placenta nutrient transport with an emphasis on macro-nutrient transporters. It highlights the changes in expression and activity of these transporters associated with common pregnancy pathologies, including intrauterine growth restriction, macrosomia, diabetes and obesity, as well as the potential impact of maternal diet. Molecular signaling pathways linking maternal nutrient availability and placenta nutrient transport are discussed. How sexual dimorphism affects fetal growth strategies and the placenta’s response to an altered intrauterine environment is considered. Further knowledge in this area may be the first step in the development of targeted interventions to help optimize fetal growth.

The analysis of Doppler flow alterations in intrauterine growth restricted pregnancies

Objective: Intrauterine growth restriction (IUGR) is a common clinical condition. For some clinicians, it is still not clear which patients should be referred to a tertiary center. In this study, we aimed to analyse the sonographic parameters of IUGR suspected pregnancies and find out which finding is the most sensitive in the diagnosis of IUGR. Methods: Doppler flow findings and biometric measurements of 50 IUGR suspected pregnancies admitted to our perinatology outpatient clinic between March 2013 and March 2014 were evaluated. 60 healthy singleton pregnancies were assigned as the control group. The same measurement were performed and compared. The diagnosis of IUGR was made on one of the followings: AC measurement ? 10 p, uterine artery RI ?0.58, the fetal growth rate ? 10 p, fetal weight ? 10 p. Gestational week was calculated regarding the last menstrual period and confirmed with the first trimester ultrasonographic findings. Results: In IUGR and control group, maternal age was 26.63 ± 5.19 and 29.48 ± 5.79, respectively (p=0.327); gravida was 1.74 ± 0.99 and 2.13 ± 1.51 (p=0.290); parity was 0.63 ± 0.89 and 0.98 ± 0.49, (p=0.703); gestational week was 34.82 ± 3.27 and 34.21 ± 4.07 (p=0.70), respectively. Umbilical artery PI was 1.51 ± 0.96 in IUGR group and 1.00 ± 0.22 in control group (p1 and umbilical artery PI >0.95 have the highest sensitivity for IUGR (Sensitivity 82% and 80%; specificity 56% and 44%, respectively). Oligohydramnios and UA/MCA PI ratio were shown to have the highest specificity (specificity 70%).

OC26.07: Differential patterns of prenatal ipsilateral and contralateral lung growth in isolated left‐sided congenital diaphragmatic hernia

Given the direct effect of the herniated viscera on the ipsilateral lung, we hypothesized that right and left fetal lung growth rates are discordant in congenital diaphragmatic hernia (CDH) with a direct relationship to the degree of visceral herniation. To address this hypothesis, we compared right and left-sided lung growth rates (ΔLV-R, ΔLV-L) in varying degrees of visceral herniation. Lung volumetric measurements were reviewed from 58 isolated left-sided CDH fetuses undergoing MRI studies at both mid- (20–30 weeks) and late-gestation (>30 weeks) time points. ΔLV-R and ΔLV-L values (mL/wk) were then compared. The impact of the degree of visceral herniation (categorized to three groups: group1-liver down, group2-liver up with stomach in abdomen or left thorax or midline, group3-liver up with stomach in right thorax) on growth disparity between the right and left lungs was then compared using one-way ANOVA. Measurable growth occurred in both lungs between the mid and late gestational time points in each of the groups. The ΔLV-R exhibited a strong linear correlation with ΔLV-L (r = 0.625). However, the right lung grew significantly faster than the left lung (ΔLV-R = 1.36 vs. ΔLV-L = 0.17 mL/wk, P < 0.001). A higher degree of visceral herniation appeared to decrease the growth rate disparity with increasing limitations on ΔLV-R (P = 0.004). Collectively, these data reveal that the contralateral lung retains the potential to grow faster than the ipsilateral lung during the third trimester in cases of isolated CDH. Furthermore, a higher degree of visceral herniation places progressive limitations on contralateral lung growth thereby diminishing the disparity between the growth rate of contralateral and ipsilateral lungs. Lastly, measurements of total lung growth in the third trimester increasingly reflect the dynamics of contralateral lung growth in cases of isolated CDH. Supporting information for OC03.07, OC07.05, OC08.03, OC09.10, OC12.03, OC13.04, OC15.06, OC17.02, OC17.04, OC18.01,OC18.02, OC18.06, OC20.03, OC22.07, OC23.03 and OC23.04 can be found in the online version of these abstracts.

Parenteral Nutrition Support in Preterm Infants

Nutrition support for preterm infants is important to achievement of a postnatal growth rate optimizing normal fetal intrauterine growth rates and for improvement of patient outcome. However, sufficient nutrient delivery is not easy because of underlying illness. Although enteral nutrition (EN) is preferred over parenteral nutrition (PN), immature gastrointestinal features and inability to suck and swallow until 33 weeks’ gestation disrupt. In patients with inability to tolerate adequate EN for more than 2 or 3 days, to optimize nutrition support and minimize complications, PN should begin within 24 hours after birth. The purpose of this study is to review the PN in preterm infants for the most appropriate nutritional support to meet each patient’s requirement.

Management of vasa previa during pregnancy.

In order to prevent fetal mortality due to vasa previa, it is necessary to obtain an antenatal diagnosis and perform elective cesarean section prior to membrane rupture. Under present circumstances, management strategies for vasa previa depend on each institutional policy. In our institution, patients are not routinely admitted, although precise outpatient management, including confirming the presence of uterine contractions and monitoring the cervical length, fetal growth and fetal heart rate, is provided for pregnant females with vasa previa. In the present report, we reviewed 21 cases of vasa previa managed at our hospital. Some 71% (15/21) of them were required inpatient management due to its complications, resulting in emergency delivery in about half of them. Therefore, our results suggest that only carefully selected asymptomatic patients may be successfully managed as outpatients.

Effect of conception date and hind nutrition on fetal growth trajectory and gestation length of red deer (Cervus elaphus)

This study tested the hypothesis that the negative association between gestation length and conception date in red deer is mediated by nutrition. Twenty-eight pregnant red deer were randomly allocated to four groups according to a 2 × 2 factorial design, with the factors conception date (14 March, E; 28 April, L) and level of nutrition (ad libitum, H; restricted, R). Animals were housed indoors in individual pens from early winter until calving and offered daily an ad libitum pelleted ration. The daily ration was then restricted from late winter in ER (134 days post-conception) and LR (89 days post-conception) groups, so that these hinds did not experience a seasonal increase in food intake. X-Ray computed tomography scans were taken at Days 120, 150, 180 and 210 of gestation (mid–late gestation) to estimate weight of various conceptus components. Growth rate of the total fetus was significantly higher in LH than in other treatments (P &lt; 0.01) between Days 180 and 210 of gestation. Birthweight was not significantly different (P &gt; 0.05) between treatments or calf sex. Birthweight was associated directly with change in hind liveweight (P = 0.03) and body condition score during the third trimester of pregnancy (P = 0.01), but was not significantly associated with gestation length (P = 0.34). Gestation length was 4.4 days longer in LR than LH hinds (P = 0.03) and was negatively associated with both food intake (P = 0.03) and LW gain (P = 0.02) during the final trimester of gestation. Feeding late-conceiving hinds an ad libitum diet of high-quality food during the third trimester of gestation maximises fetal growth and shortens gestation length.

Birth weight and academic achievement in childhood.

Research has shown that birth weight has a lasting impact on later-life outcomes such as educational attainment and earnings. This paper examines the role of health at birth in determining academic achievement in childhood, which may provide the link between birth weight and adult outcomes. Using three waves of the Child Development Supplement of the Panel Study of Income Dynamics data over 1997-2007, we build on the literature by employing the fetal growth rate as a proxy for net nutritional intake in utero and propose a nested error-component two-stage least squares estimator that draws on internal instruments from alternative dimensions of the multilevel panel data set. In particular, this alternative estimator allows us to exploit the information on children with no siblings in the sample, which comprise over 40% of the observations in our sample, as well as to obtain coefficient estimates for the time-invariant variables such as race and maternal education. This would not be feasible with the usual mother fixed effects estimation. We obtain modest but significant effects of both birth weight and the fetal growth rate on math and reading scores, with the effects concentrated in the low birth weight range. Infant health measures appear to explain little of the well-documented racial disparity in test scores.

A physiological increase in insulin suppresses muscle-specific ubiquitin ligase gene activation in fetal sheep with sustained hypoglycemia.

Decreased glucose transfer to the fetus is characteristic of pregnancies complicated by maternal under nutrition and placental insufficiency. Chronic experimental restriction of glucose transfer to the sheep fetus for the final 40% of gestation with a maternal insulin infusion (HG fetuses) results in fetal hypoglycemia, hypoinsulinemia, and decreased rates of fetal growth and protein accretion compared to controls (CON). Lower rates of fetal protein accretion are due to increased fetal protein breakdown and not decreased protein synthesis. However, the specific skeletal muscle pathways responsible for increased protein breakdown have not been determined. Nor has it been determined if low fetal glucose or insulin concentrations are more important for regulating these skeletal muscle protein breakdown pathways. We tested whether chronic restriction of glucose transfer to the fetus increased the ubiquitin–proteosome pathway or autophagy‐lysosome pathway in fetal sheep skeletal muscle and found no evidence for an increase in the autophagy‐lysosome pathway. However, HG fetuses had increase mRNA expression of MaFBx1 (twofold, P <0.01) and a trend for increased mRNA expression of MuRF1 (P =0.08) compared to CON. A subset of chronically hypoglycemic fetuses received an isoglycemic insulin infusion for the final 7 days of the maternal insulin infusion (HG + INS fetuses) and had MaFBx1 and MuRF1 mRNA concentrations similar to CON fetuses. These results demonstrate that fetuses exposed to sustained hypoglycemia have decreased protein accretion due to activation of the skeletal muscle ubiquitin–proteosome pathway and that a fetal hyperinsulinemic clamp can suppress this pathway even in the context of continued hypoglycemia.

The effect of maternal body mass index on fetal growth: use of individualized growth assessment and two-level linear modeling.

To determine the effect of maternal body mass index on fetal growth using individualized growth assessment and two-level linear modeling. A retrospective review of biometry in the second and third trimesters from 246 normal, term singleton fetuses was performed. Four to eight biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur diaphysis length (FDL) measurements per fetus were available and used to determine second-trimester growth rates. Expected third-trimester size trajectories were generated from these data and Percent Deviations [%Dev = ((observed - expected)/expected) × 100] were calculated. Two-level linear modeling was used to determine %Dev slopes and the effect of body mass index (BMI) on these slopes. Relationships between individual second- and third-trimester slopes and BMI were evaluated using linear regression. Linear regression analysis of second-trimester growth indicated no significant relationships between the fetal growth rate and the BMI in the second trimester [R(2) (adj): 0.0% to 1.0% except AC in one subgroup (5.6%)]. Regression analysis did not indicate a significant relationship (adj R(2) : 0%-0.2%) between BMI and third-trimester %Dev slopes for any anatomic parameter. Two-level statistical modeling showed no effect of BMI on BPD, AC, or FDL growth and only a moderate effect on the HC growth in the third trimester. Our findings indicate that the maternal BMI does not have an effect on fetal growth in either the second or the third trimester as determined with individualized growth assessment.

Life history of harbor porpoises (Phocoena phocoena) in Scottish (UK) waters

AbstractLife history parameters were determined for stranded and bycaught harbor porpoises (Phocoena phocoena) from Scottish (UK) waters (1992–2005). Fetal growth rate was 84.4 mm/mo and mean size at birth was 76.4 cm (range 65–88 cm). Males and females had a similar range of body lengths (65–170 cm and 66–173 cm, respectively), although asymptotic lengths were higher in females than males (approximately 158 cm and 147 cm, respectively). Nonpregnant females were significantly lighter, in relation to their length than males. Maximum estimated age was 20 yr for both sexes. Age at sexual maturity (ASM) was estimated as 4.35 yr in females and 5.00 yr in males. Conception occurred mainly in July and August although reproductively active males were recorded during April to July. Gestation lasted 10–11 mo, with calving mainly between May and July. Lactating females were recorded during June to November, while small calves with solid food in their stomachs were found mainly during February to May. Estimated pregnancy rate (0.34–0.40) is lower than recorded elsewhere, but is likely underestimated due to the prevalence of mature females of poor health status in the sample. Nevertheless, cetacean strandings can be an essential source of data on demographic parameters.

Placental weight and foetal growth rate as predictors of ischaemic heart disease in a Swedish cohort.

Studies on placental size and cardiovascular disease have shown inconsistent results. We followed 10,503 men and women born in Uppsala, Sweden, 1915-1929 from 1964 to 2008 to assess whether birth characteristics, including placental weight and placenta/birth weight ratio, were predictive of future ischaemic heart disease (IHD). Adjustments were made for birth cohort, age, sex, mother's parity, birth weight, gestational age and social class at birth. Placental weight and birth weight were negatively associated with IHD. The effect of placental weight on IHD was stronger in individuals from medium social class at birth and in those with low education. Men and women from non-manual social class at birth had the lowest risk for IHD as adults. We conclude that low foetal growth rate rather than placental weight was more predictive of IHD in the Swedish cohort. However, the strong effect of social class at birth on risk for IHD did not appear to be mediated by foetal growth rate.

Maternal parity, fetal and childhood growth, and cardiometabolic risk factors.

We examined the associations of maternal parity with fetal and childhood growth characteristics and childhood cardiometabolic risk factors in a population-based prospective cohort study among 9031 mothers and their children. Fetal and childhood growth were repeatedly measured. We measured childhood anthropometrics, body fat distribution, left ventricular mass, blood pressure, blood lipids, and insulin levels at the age of 6 years. Compared with nulliparous mothers, multiparous mothers had children with higher third trimester fetal head circumference, length and weight growth, and lower risks of preterm birth and small-size-for-gestational-age at birth but a higher risk of large-size-for-gestational-age at birth (P<0.05). Children from multiparous mothers had lower rates of accelerated infant growth and lower levels of childhood body mass index, total fat mass percentage, and total and low-density lipoprotein cholesterol than children of nulliparous mothers (P<0.05). They also had a lower risk of childhood overweight (odds ratio, 0.75 [95% confidence interval, 0.63–0.88]). The risk of childhood clustering of cardiometabolic risk factors was not statistically significantly different (odds ratio, 0.82; 95% confidence interval, 0.64–1.05). Among children from multiparous mothers only, we observed consistent trends toward a lower risk of childhood overweight and lower cholesterol levels with increasing parity (P<0.05). In conclusion, offspring from nulliparous mothers have lower fetal but higher infant growth rates and higher risks of childhood overweight and adverse metabolic profile. Maternal nulliparity may have persistent cardiometabolic consequences for the offspring.

Regulation and function of the peg3 imprinted domain.

A subset of mammalian genes differ functionally between two alleles due to genomic imprinting, and seven such genes (Peg3, Usp29, APeg3, Zfp264, Zim1, Zim2, Zim3) are localized within the 500-kb genomic interval of the human and mouse genomes, constituting the Peg3 imprinted domain. This Peg3 domain shares several features with the other imprinted domains, including an evolutionarily conserved domain structure, along with transcriptional co-regulation through shared cis regulatory elements, as well as functional roles in controlling fetal growth rates and maternal-caring behaviors. The Peg3 domain also displays some unique features, including YY1-mediated regulation of transcription and imprinting; conversion and adaptation of several protein-coding members as ncRNA genes during evolution; and its close connection to human cancers through the potential tumor suppressor functions of Peg3 and Usp29. In this review, we summarize and discuss these features of the Peg3 domain.

Peg3 Mutational Effects on Reproduction and Placenta-Specific Gene Families

Peg3 (paternally expressed gene 3) is an imprinted gene encoding a DNA-binding protein. This gene plays important roles in controlling fetal growth rates and nurturing behaviors. In the current study, a new mutant mouse model has been generated to further characterize the functions of this DNA-binding protein. Besides known phenotypes, this new mutant model also revealed potential roles of Peg3 in mammalian reproduction. Female heterozygotes produce a much smaller number of mature oocytes than the wild-type littermates, resulting in reduced litter sizes. According to genome-wide expression analyses, several placenta-specific gene families are de-repressed in the brain of Peg3 heterozygous embryos, including prolactin, cathepsin and carcinoembryonic antigen cell adhesion molecule (Ceacam) families. The observed de-repression is more pronounced in females than in males. The de-repression of several members of these gene families is observed even in the adult brain, suggesting potential defects in epigenetic setting of the placenta-specific gene families in the Peg3 mutants. Overall, these results indicate that Peg3 likely controls the transcription of several placenta-specific gene families, and further suggest that this predicted transcriptional control by Peg3 might be mediated through unknown epigenetic mechanisms.

Low birth weight, small for gestational age and preterm births before and after the economic collapse in Iceland: a population based cohort study.

ObjectiveInfants born small for gestational age (SGA) or preterm have increased rates of perinatal morbidity and mortality. Stressful events have been suggested as potential contributors to preterm birth (PB) and low birth weight (LBW). We studied the effect of the 2008 economic collapse in Iceland on the risks of adverse birth outcomes.Study designThe study population constituted all Icelandic women giving birth to live-born singletons from January 1st 2006 to December 31st 2009. LBW infants were defined as those weighing <2500 grams at birth, PB infants as those born before 37 weeks of gestation and SGA as those with a birth weight for gestational age more than 2 standard deviations (SD's) below the mean according to the Swedish fetal growth curve. We used logistic regression analysis to estimate odds ratios [OR] and corresponding 95 percent confidence intervals [95% CI] of adverse birth outcomes by exposure to calendar time of the economic collapse, i.e. after October 6th 2008.ResultsCompared to the preceding period, we observed an increased adjusted odds in LBW-deliveries following the collapse (aOR = 1.24, 95% CI [1.02, 1.52]), particularly among infants born to mothers younger than 25 years (aOR = 1.85, 95% CI [1.25, 2.72]) and not working mothers (aOR = 1.61, 95% CI [1.10, 2.35]). Similarly, we found a tendency towards higher incidence of SGA-births (aOR = 1.14, 95% CI [0.86, 1.51]) particularly among children born to mothers younger than 25 years (aOR = 1.87, 95% CI [1.09, 3.23]) and not working mothers (aOR = 1.86, 95% CI [1.09, 3.17]). No change in risk of PB was observed. The increase of LBW was most distinct 6–9 months after the collapse.ConclusionThe results suggest an increase in risk of LBW shortly after the collapse of the Icelandic national economy. The increase in LBW seems to be driven by reduced fetal growth rate rather than shorter gestation.

Placental Vascular Dysfunction, Fetal and Childhood Growth, and Cardiovascular Development

Background— Suboptimal fetal nutrition may influence early growth and cardiovascular development. We examined whether umbilical and uterine artery resistance indices, as measures of feto-placental and utero-placental vascular function, respectively, are associated with fetal and childhood growth and cardiovascular development. Methods and Results— This study was embedded in a population-based prospective cohort study among 6716 mothers and their children. Umbilical artery pulsatility index and uterine artery resistance index and fetal growth were measured in third trimester. Childhood growth was repeatedly assessed from birth to the age of 6 years. We measured body fat distribution, left ventricular mass, and blood pressure at the age of 6 years. Higher third trimester umbilical and uterine artery vascular resistance were associated with lower fetal length and weight growth in third trimester resulting in a smaller size at birth among boys and girls ( P values &lt; 0.05). These differences in length and weight growth became smaller from the age of 6 months onwards, but were still present at the age of 6 years. Higher third trimester umbilical artery vascular resistance, but not uterine artery vascular resistance, was associated with higher childhood body mass index, total fat mass, android/gynoid fat mass ratio, and systolic blood pressure, and with a lower left ventricular mass ( P values&lt;0.05). These associations were not explained by birth weight. Stronger associations tended to be present among girls as compared with boys. Conclusions— Higher third trimester feto-placental vascular resistance, but not utero-placental vascular resistance, was associated with slower fetal growth rates and cardiovascular adaptations in childhood.

Defining the relationship between fetal Doppler indices, abdominal circumference and growth rate in severe fetal growth restriction using functional linear discriminant analysis

The relationship between Doppler measurements, size and growth rate in fetal growth restriction has not been defined. We used functional linear discriminant analysis (FLDA) to investigate these parameters taking account of the difficulties inherent in exploring relationships between repeated observations from a small number of cases. In 40 fetuses with severe growth restriction, serial abdominal circumference (AC), umbilical, middle cerebral artery (MCA) and ductus venosus Doppler pulsatility index measurements were recorded. In 11 singleton fetuses with normal growth, umbilical artery pulsatility index only was measured. Data were expressed as z-scores in relation to gestation and analysed longitudinally using FLDA. In severe growth restriction, the Spearman correlation coefficients between umbilical artery pulsatility index and AC z-score, MCA pulsatility index and AC z-score and ductus venosus pulsatility index z-score and AC z-score were, respectively: -0.36, p = 4.4 × 10(-7); 0.70, p = 1.1 × 10(-17) and -0.50, p = 8.1 × 10(-4). No relationship was seen between Doppler parameters and growth rate. There was no relationship between umbilical artery pulsatility index and AC nor growth rate in normally grown fetuses. In severe fetal growth restriction, Doppler changes are related to absolute fetal AC size, not growth rate.

Maternal and neonatal outcomes of placenta previa and placenta accreta: three years of experience with a two-consultant approach.

ObjectiveThe aim of this retrospective cohort study was to evaluate maternal and neonatal outcomes in patients with placenta previa (PP) and placenta accreta (PA).MethodsThe study population comprised all patients who had a cesarean section for PP and PA at a tertiary referral hospital in Taif, Kingdom of Saudi Arabia, from December 2009 to December 2012. Maternal and neonatal data were obtained from medical records and the hospital database system. PA cases were managed by a multispeciality team, including two obstetric consultants.ResultsIn total, 122 patients with PP were identified, with PA found in 25 cases. The median intraoperative blood loss in cases of PA was 2,000 (mean 3,000) mL, with a loss of ≥2,000 mL occurring in 72%, and ≥5,000 mL in 20%. The median packed red blood cell transfusion requirement was 6 (mean 7.7) units, and 28% received ≥10 units. Fetal growth restriction was diagnosed in two cases with known maternal medical disorders. Four cases (3.3%) were diagnosed as small for gestational age. The mean birth weight of the neonates was at the 10th–50th percentile according to Hadlock fetal growth charts.ConclusionThe presence of a second obstetric consultant among the multispeciality team during surgery for PA was associated with a reduction in blood loss and a decreased need for large-volume blood transfusion. The rate of fetal growth restriction/small for gestational age in PP was average, but the babies were relatively small (level 2 evidence).