Outcome In Fetal Growth Restriction Research Articles

Etiologic evaluation and pregnancy outcomes of fetal growth restriction (FGR) associated with structural malformations

This study aimed to evaluate the etiology and pregnancy outcomes of fetuses underwent invasive prenatal diagnosis for fetal growth restriction (FGR) accompanied by structural malformations. Data from 130 pregnancies referred for prenatal diagnosis for FGR accompanied by structural malformations were obtained between July 2011 and July 2023. Traditional karyotyping was conducted for all the subjects. A total of 37 (28.5%) cases of chromosomal abnormalities were detected by karyotyping, including 30 cases of numerical anomalies and seven cases of unbalanced structural anomalies. Trisomy 18 was the most common abnormalities, accounting for 51.4%, significantly higher than any other chromosomal abnormality. The cohort was predominantly comprised of early-onset FGR (88.5%) compared to late-onset FGR (11.5%). The incidences of chromosomal abnormalities in this two groups were 29.6% (34/115) and 20.0% (3/15), respectively (p > 0.05). The majority (74.6%, 97/130) of the cohort were affected by a single system malformation, with chromosomal abnormalities found in 19.6% (19/97) of cases. In pregnancies of structural malformations involving two and multiple systems, the frequencies were 56.5% (13/23), and 50.0% (5/10), respectively. Single nucleotide polymorphism array (SNP array) was performed in parallel for 65 cases, revealing additional 7.7% cases of copy number variants (CNVs) compared to karyotyping. Polymerase chain reaction (PCR) was used for detection of cytomegalovirus (CMV) DNA in 92 cases. All fetuses with FGR associated with two or more system malformations were either terminated or stillborn, irrespective of chromosomal aberrations. Conversely, 71.8% of pregnancies with a single-system malformation and normal genetic testing results resulted in live births. Furthermore, two (2.2%) cases tested positive for CMV DNA, leading to one termination and one case of serious developmental disorder after birth. Our study suggests that structural malformations associated with FGR are more likely to affect a single organ system. When multiple systems are involved, the incidence of chromosomal abnormalities and termination rates are notably high. We advocate for the use of CMA and CMV DNA examinations in FGR cases undergo invasive prenatal diagnosis, as these tests can provide valuable insights for etiological exploration and pregnancy management guidance.

Perinatal outcomes following abdominoplasty: a retrospective study and review of current literature

BackgroundAbdominoplasty surgery is a common body contouring surgery to remove excess fat and skin and restore weakened or separated abdominal muscles caused by aging, pregnancy, or weight fluctuations. There is scant literature regarding patient and pregnancy outcomes following abdominoplasty. We sought to determine if there was a correlation between adverse pregnancy outcomes and a history of abdominoplasty. MethodsWe used a large federated de-identified national health research network with data sourced from 68 health care organizations within the United States (TriNetX, data accessed August 19, 2022). All patients with a record of pregnancy were identified using ICD-10/9 codes and were grouped into those with a history of abdominoplasty and those without. We evaluated the perinatal outcomes of fetal growth restriction, abnormal umbilical artery dopplers, gestational hypertension, pre-eclampsia, preterm delivery, preterm prelabor rupture of membranes, gestational diabetes, macrosomia, stillbirth, abnormal placentation, and wound disruption/infection occurring during a patient's pregnancy following abdominoplasty. Propensity matching was performed to account for potential confounders. An alpha level of < 0.05 was considered statistically significant. ResultsOf the 44,737 patients meeting our criteria, 304 had a history of abdominoplasty while 44,433 did not (Control). We found that patients with a history of abdominoplasty had significantly higher gravidity, were largely located in the Southern and Midwest region, and had higher counts of vaginal deliveries and cesarean sections, when compared to the Control cohort (Table 1). After propensity score matching, we found lower risk of pre-eclampsia and PPROM in patients with abdominoplasty (OR [95%CI] = 0.46 [0.32, 0.67], p < 0.0001, Table 2). Furthermore, abdominoplasty was associated with increased risk of preterm delivery (OR [95%CI] = 2.15 [1.48, 3.13], p = 0.0002, Table 2). We did not find significant differences in the other perinatal outcomes (Table 2). DiscussionOur data suggest that abdominoplasty may be associated with a relative increase in rates of preterm delivery and cesarean delivery, but other perinatal outcomes are not increased. This provides evidence that future desire for pregnancy need not be a relative contraindication to abdominoplasty.

The search for blood biomarkers that indicate risk of adverse neurodevelopmental outcomes in fetal growth restriction.

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=369242, Identifier CRD42022369242.

142 Estimated fetal weight versus abdominal circumference in predicting adverse outcome in fetal growth restriction

142 Estimated fetal weight versus abdominal circumference in predicting adverse outcome in fetal growth restriction

Comparing outcomes of fetal growth restriction defined by estimated fetal weight versus isolated abdominal circumference.

The objective of this study was to compare maternal and neonatal outcomes when the diagnosis of FGR was based on isolated abdominal circumference < 10th percentile for gestational age (GA) (iAC group) versus overall estimated fetal weight < 10th percentile (EFW group). This was a retrospective cohort study of singleton gestations who underwent growth ultrasounds and delivered at a single health system from 1/1/19-9/4/20. The study group was comprised of patients with AC < 10th percentile and EFW ≥ than the 10th percentile (iAC group). The control group included patients with overall EFW < 10th percentile (EFW group). Outcomes evaluated included GA at delivery, mode of delivery, fetal and neonatal outcomes. Data was analyzed using Mann Whitney U, X2, and Fisher exact tests with significance defined as p < 0.05. 635 women met the inclusion criteria, 259 women in the iAC group and 376 women in the EFW group. The iAC group was noted to have a later GA at diagnosis and delivery. iAC was associated with lower rates of preterm birth (PTB), NICU admission, SGA at delivery and umbilical artery cord gas < 7.0. Using iAC as a definition of FGR increased the number of FGR cases by 1.69-fold over EFW criteria alone. However, obstetrical and neonatal outcomes for the iAC group appear to be significantly better than those in the EFW group, with low rates of PTB, NICU admission, and umbilical artery cord gas < 7.0.

EP13.14: The role of fetal right heart modified myocardial performance index in prediction of adverse perinatal outcomes in fetal growth restriction

EP13.14: The role of fetal right heart modified myocardial performance index in prediction of adverse perinatal outcomes in fetal growth restriction

OC14.05: The Delphi consensus and placental biomarkers in the prediction of adverse neonatal outcomes in fetal growth restriction

OC14.05: The Delphi consensus and placental biomarkers in the prediction of adverse neonatal outcomes in fetal growth restriction

Predictors of adverse perinatal outcomes in fetal growth restriction using a combination of maternal clinical factors and simple ultrasound parameters.

To identify predictors of adverse perinatal outcomes in pregnancies with fetal growth restriction (FGR) using a combination of maternal clinical factors and simple ultrasound parameters and develop a risk-scoring model for predicting adverse perinatal outcomes. A retrospective study of 370 non-anomalous singleton pregnancies with FGR was conducted. Multivariate logistic regression analysis was used to identify factors associated with adverse perinatal outcomes; P< 0.05 was considered statistically significant. The discriminative ability was measured with the area under the receiver operating characteristic curve (AUC). A weighted score for each predictor was calculated. Adverse perinatal outcomes occurred in 165/370 (44.6%) cases. There were eight predictive factors, including a history of pregnancy-induced hypertension (PIH) (score=1), chronic hypertension (score=3), PIH (score=2), maternal weight gain less than 8kg (score=1), early-onset FGR (score=1), estimated fetal weight less than 5th percentile (score=2), amniotic fluid index less than 5cm (score=3), and abnormal umbilical artery Doppler (score=2), with total scores ranging from 0 to 15. AUC for the eight-item predictive model was 0.799 (95% confidence interval 0.753-0.845). A combination of maternal clinical factors and simple ultrasound parameters showed acceptable predictive performance for adverse perinatal outcomes in FGR.

Could serotonin play a role in abnormal brain outcomes in fetal growth restriction?

Could serotonin play a role in abnormal brain outcomes in fetal growth restriction?

Perinatal Outcomes of Fetal Growth Restriction, Classified According to the Delphi Consensus Definition: A Prospective Observational Study

Perinatal Outcomes of Fetal Growth Restriction, Classified According to the Delphi Consensus Definition: A Prospective Observational Study

Combination of Doppler measurements with amniotic fluid volume for the prediction of perinatal outcomes in fetal growth restriction.

We aimed to evaluate a new ratio of amniotic fluid volume (AFV) to Doppler measurements, and compare its association with adverse perinatal outcomes (APOs) in fetal growth restriction (FGR). This prospective study included pregnant women with singleton fetal growth-restricted fetuses. Each participant underwent a detailed ultrasonographic examination. Uterine artery pulsatility index, umbilical artery pulsatility index (UA PI), middle cerebral artery pulsatility index (MCA PI), cerebroplacental ratio (CPR), and umbilical-to-cerebral ratio (UCR) were calculated, and the single deepest pocket (SDP) technique was used to estimate AFV. Amniotic-umbilical-to-cerebral ratio (AUCR) was calculated as the ratio of SDP to UCR: AUCR=SDP / (UA PI/MCA PI). APO was defined as umbilical venous cord blood pH <7.10, 5-minute APGAR score <7, and neonatal intensive care unit admission. We compared the fetal ultrasonographic and demographic features between the APO and the non-APO groups. The mean UA PI and UCR were significantly higher in the APO group. The mean SDP, CPR, and AUCR were significantly lower in the APO group. Receiver operating characteristic curve analyses demonstrated the highest area under the curve value (0.882; P < 0.001) for AUCR to APOs. The current study suggests that AUCR is the best predictor for APOs in FGR.

Middle cerebral artery to uterine artery pulsatility index ratios in pregnancy with fetal growth restriction regarding negative perinatal outcomes

Background/Aim: Fetal growth restriction (FGR) causes a high risk of perinatal morbidity and mortality, and the timing of the correct delivery time decision remains controversial. Cerebroplacental ratio (CPR), umbilical artery, uterine artery (UA) and middle cerebral artery (MCA) Doppler studies are used to predict adverse perinatal outcomes in FGR. However, since there is insufficient reliability for each separately and together, the search for new methods continues. This retrospective study was conducted to determine the degree of neonatal morbidity in fetuses suspected of having FGR by evaluating the MCA to UA pulsatility index (PI) ratios together with frequently used Doppler examinations. Methods: This was a retrospective cohort study conducted in a single-center hospital with the approval of the Medical Institutional Ethics Committee. A total of 424 pregnant women admitted to a tertiary hospital and diagnosed with FGR between July 2020 and December 2021 who were informed and approved were included in the study. Gestational age was confirmed by first trimester sonographic measurements of pregnancy. All pregnant women were examined by Doppler USG and umbilical artery, mean UA, fetal MCA, ductus venosus, CPR (MCA/umbilical artery pulsatility index ratio) and cerebrouterine ratio (MCA/UA) PI values were measured. Negative perinatal outcomes were recorded as blood gas level of the newborn at 7.2 and below, Apgar score of 7 and below at the fifth minute, and needing neonatal intensive care (NICU). Adverse perinatal and postnatal outcomes were recorded and compared with Doppler findings. If there were no signs of a negative perinatal outcome, it was considered a positive outcome. If at least one of the symptoms of adverse perinatal outcomes was present, it was considered a negative outcome Results: Decreased CPR and decreased MCA to UA PI were significantly and positively associated with an increased likelihood of exhibiting negative perinatal outcomes in pregnancies with FGR (P &lt; 0.001, P &lt; 0.001, respectively). The receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off value for MCA to uterine artery PI was 1.41 to predict FGR with 57.37% sensitivity and 62.50% specificity (AUC: 0.629; 95% CI: 0.581–0.675). When the CPR cut-off value was taken as 1.2069, the sensitivity was 42.86% and the specificity 83.93% in predicting negative perinatal outcomes in CPR values below this value (P &lt; 0.001). Conclusion: CPR is the most successful criterion in distinguishing between positive and negative perinatal outcomes. It has been demonstrated that the MCA to uterine artery PI ratio values after CPR can also be used for this distinction. MCA to UA PI ratio sensitivity was higher than CPR and umbilical artery. This situation shows that MCA to uterine artery PI ratio (alone or when evaluated together with PPV and NPV ratios) is a criterion that can be added to other Doppler examinations in predicting negative perinatal outcomes.

Chronic histiocytic intervillositis (CHI): current treatments and perinatal outcomes, a systematic review and a meta-analysis.

BackgroundChronic histiocytic intervillositis (CHI) is a rare placental lesion with a high recurrence rate and poor perinatal outcomes. There are currently limited guidelines regarding the diagnosis of this condition in the index pregnancy and treatment where recurrence is suspected.ObjectiveThe primary objective of this systematic review and meta-analysis was to determine the perinatal outcomes of pregnancies affected by chronic histiocytic intervillositis and to what extent they can be improved with treatment. The secondary objective was to assess the relationship between CHI lesion severity and pregnancy loss.MethodsA systematic search of Ovid Embase, Web of Science, Science Direct, PubMed, Ovid Medline, Google Scholar and CINAHL was carried out. Case reports, cohort, case-control and randomised controlled trials (RCT) detailing the perinatal outcomes of CHI pregnancies, both treated and untreated, were included.ResultsNo RCTs were identified. However, in a review population of 659 pregnancies, with additional 7 in case reports, CHI treatments included aspirin, prednisone, prednisolone, low molecular weight heparin (LMWH), hydroxychloroquine and adalimumab. A descriptive synthesis of data found mixed results for treatments in relation to live birth, miscarriage and fetal growth restriction outcomes. Furthermore, quantitative synthesis of 38 pregnancies revealed a non-significant improvement in live birth rate with CHI targeted treatment (OR 1.79 [95% CI 0.33-9.61] (p=0.50), while meta-analysis of CHI severity in line with pregnancy loss, in a sample of 231 pregnancies, revealed lower odds of pregnancy loss with less severe lesions (OR: 0.17 [0.03-0.80], p=0.03).ConclusionsThis systematic review and meta-analysis reinforce notions surrounding the insufficient evidence for CHI treatment. It also strengthens previous hypotheses detailing the positive association between CHI lesion severity and odds of pregnancy loss. Aspirin, LMWH, prednisolone, hydroxychloroquine and adalimumab are candidates with varying levels of weak to moderate evidence supporting their use. Further prospective research is required to obtain robust evidence pertaining to treatment safety and efficacy and optimal drug regimes.Systematic Review Registration[website], identifier CRD42021237604

Relationship Between Peak Systolic Velocity in Pulmonary Artery Color Doppler and Neonatal Respiratory Outcomes in Fetal Growth Restriction With Abnormal Fetoplacental Circulation: A Prospective Cohort Study

Objectives: Newborns with fetal growth restriction (FGR) are at a high risk of prenatal mortality and morbidity compared to infants with appropriate intrauterine growth. The importance of Doppler ultrasound as a non-invasive method for estimating the pulmonary artery pressure (PAP) in newborns and adults has been mentioned in many studies. This study investigated the relationship between peak systolic velocity in pulmonary artery color Doppler and neonatal respiratory outcomes in FGR with abnormal fetoplacental circulation. Materials and Methods: In this prospective cohort study, 60 pregnant women with a gestational age of 32-37 weeks were studied in two groups: group I (women with fetus suspected of FGR according to ultrasound assessment) and group II (women with normal pregnancy). All women underwent Doppler ultrasound of pulmonary artery, umbilical artery, middle cerebral artery, and venous ductus. The pick systolic velocity (PSV) of the trunk of the pulmonary artery was evaluated in the fetus of all participants. After delivery, all infants were studied for respiratory outcomes at birth. Finally, variables included gestational age, fetal estimated weight based on Hadlock table, fetal amniotic fluid index, maternal parity, umbilical artery pulsatility index (PI), middle cerebral artery PI, maximum pulmonary artery velocity (PV), umbilical artery to middle cerebral artery index ratio, and the number of infants admitted to the newborn intensive care unit (NICU) due to respiratory distress were compared between two groups. Results: Our results showed a significant association between pulmonary artery PI in FGR fetuses with abnormal fetoplacental circulation. The rate of early NICU hospitalization of infants in the group I was higher than group II due to respiratory diseases, as well as the need for oxygen and continuous positive airway pressure (CPAP). Conclusions: Pulmonary artery color Doppler ultrasound can be effective in diagnosing FGR embryos during pregnancy and making the necessary predictions to reduce prenatal mortality and morbidity in these infants.

Perinatal and Neonatal Outcomes in Fetal Growth Restriction and Small for Gestational Age.

Alterations in intrauterine fetal growth increase the risk of adverse perinatal and neonatal outcomes. In this retrospective study, we analyzed data of 906 pregnancies collected in our maternal fetal medicine center, with different patterns of growth: 655 AGA (Appropriate for Gestational Age), 62 SGA (Small for Gestational Age: fetuses born with a weight less than 10° centile, not diagnosed before delivery), 189 FGR (Fetal Growth Restriction, classified in early and late according to gestational week at diagnosis). For each group, we compared maternal characteristics, gestational age at delivery, and perinatal and neonatal outcomes. Risk factors for fetal growth alterations were advanced age, being primiparous, and a lower pregestational BMI. FGR fetuses were born at earlier gestational ages (32 [IQR 29–38] early-FGR and 38 [IQR 36–39] late-FGR), with blood gas values comparable to the AGA group but worse neonatal outcomes related to prematurity. Unexpected SGA fetuses born by vaginal delivery, managed as AGA, were more hyperlactacidemic (4.4 [IQR 2.7–5.5]) and hypoxemic (−5.0 [IQR −7.1–2.8]) at birth than both AGA and FGR. However, neonatal outcomes (accesses and days of hospitalization in NICU) were better than FGR, likely due to gestational age and birthweight similar to AGA.

Hepatitis E, Schistosomiasis and Echinococcosis-Prevalence in a Cohort of Pregnant Migrants in Germany and Their Influence on Fetal Growth Restriction.

Background: Infections, as well as adverse birth outcomes, may be more frequent in migrant women. Schistosomiasis, echinococcosis, and hepatitis E virus (HEV) seropositivity are associated with the adverse pregnancy outcomes of fetal growth restriction and premature delivery. Methods: A cohort study of 82 pregnant women with a history of migration and corresponding delivery of newborns in Germany was conducted. Results: Overall, 9% of sera tested positive for anti-HEV IgG. None of the patients tested positive for anti-HEV IgM, schistosomiasis, or echinococcus serology. Birth weights were below the 10th percentile for gestational age in 8.5% of the neonates. No association between HEV serology and fetal growth restriction (FGR) frequency was found. Conclusions: In comparison to German baseline data, no increased risk for HEV exposure or serological signs of exposure against schistosomiasis or echinococcosis could be observed in pregnant migrants. An influence of the anti-HEV serology status on fetal growth restriction could not be found.

Significance of intermittent absent end-diastolic flow in the umbilical artery in predicting neonatal morbidity

Umbilical artery Doppler (UAD) velocimetry is utilized to assess fetal status in fetal growth restriction (FGR). Absent end-diastolic flow (AEDF) is indicative of increased placental resistance and is associated with poor fetal/neonatal outcomes. However, there is a dearth of data regarding the significance of intermittent AEDF (iAEDF) compared to persistent AEDF (pAEDF). This study compared the fetal and neonatal outcomes in FGR with iAEDF and pAEDF.

Neonatal outcomes in fetal growth restriction diagnosed using estimated fetal weight versus abdominal circumference

Neonatal outcomes in fetal growth restriction diagnosed using estimated fetal weight versus abdominal circumference

VP38.04: Study of modified myocardial performance index and its prognostic significance for adverse perinatal outcome in fetal growth restriction

VP38.04: Study of modified myocardial performance index and its prognostic significance for adverse perinatal outcome in fetal growth restriction

Widespread implementation of a low-cost telehealth service in the delivery of antenatal care during the COVID-19 pandemic: an interrupted time-series analysis

BackgroundLittle evidence is available on the use of telehealth for antenatal care. In response to the COVID-19 pandemic, we developed and implemented a new antenatal care schedule integrating telehealth across all models of pregnancy care. To inform this clinical initiative, we aimed to assess the effectiveness and safety of telehealth in antenatal care.MethodsWe analysed routinely collected health data on all women giving birth at Monash Health, a large health service in Victoria (Australia), using an interrupted time-series design. We assessed the impact of telehealth integration into antenatal care from March 23, 2020, across low-risk and high-risk care models. Allowing a 1-month implementation period from March 23, 2020, we compared the first 3 months of telehealth integrated care delivered between April 20 and July 26, 2020, with conventional care delivered between Jan 1, 2018, and March 22, 2020. The primary outcomes were detection and outcomes of fetal growth restriction, pre-eclampsia, and gestational diabetes. Secondary outcomes were stillbirth, neonatal intensive care unit admission, and preterm birth (birth before 37 weeks' gestation).FindingsBetween Jan 1, 2018, and March 22, 2020, 20 031 women gave birth at Monash Health during the conventional care period and 2292 women gave birth during the telehealth integrated care period. Of 20 154 antenatal consultations provided in the integrated care period, 10 731 (53%) were delivered via telehealth. Overall, compared with the conventional care period, no significant differences were identified in the integrated care period with regard to the number of babies with fetal growth restriction (birthweight below the 3rd percentile; 2% in the integrated care period vs 2% in the conventional care period, p=0·72, for low-risk care models; 5% in the integrated care period vs 5% in the conventional care period, p=0·50 for high-risk care models), number of stillbirths (1% vs 1%, p=0·79; 2% vs 2%, p=0·70), or pregnancies complicated by pre-eclampsia (3% vs 3%, p=0·70; 9% vs 7%, p=0·15), or gestational diabetes (22% vs 22%, p=0·89; 30% vs 26%, p=0·06). Interrupted time-series analysis showed a significant reduction in preterm birth among women in high-risk models (–0·68% change in incidence per week [95% CI −1·37 to −0·002]; p=0·049), but no significant differences were identified in other outcome measures for low-risk or high-risk care models after telehealth integration compared with conventional care.InterpretationTelehealth integrated antenatal care enabled the reduction of in-person consultations by 50% without compromising pregnancy outcomes. This care model can help to minimise in-person interactions during the COVID-19 pandemic, but should also be considered in post-pandemic health-care models.FundingNone.