ABSTRACT
OBJECTIVES@#Early onset fetal growth restriction substantially contributes to neonatal mor-bidities and mortalities. The main dilemma lies on the timing of delivery, especially for pre- and peri-viable fetuses, due to the challenge in creating an ideal balance of minimized in-utero hy- poxia-induced fetal injury or death versus the risks of iatrogenic preterm delivery. We wished to determine the ideal timing of delivery among growth-restricted fetuses <32 weeks gestation us- ing a stage-based doppler protocol.@*MATERIALS AND METHODS@#A retrospective-cohort study of 67 singleton-pregnant wom- en with growth restriction at <32 weeks gestation and hospitalized from January 2010 to Sep- tember 2021 was conducted. Medical records were reviewed, and the outcomes were extracted. The primary outcomes were arterial pH at birth and mortality, while secondary outcomes includ- ed neonatal morbidities.@*RESULTS@#Fetal growth restriction progressed by an average of 3 stages (41.79%) within a 2- to 3.5-week period. More than half had arterial pH <7.20, which was lowest at Stage II FGR (50.00%). The prevalence of neonatal mortality was 16.42% and was lowest at Stage I (8.70%) and Stage II FGR (18.75%).@*CONCLUSION@#Doppler studies may be conducted weekly for Stage I, biweekly for Stage II, every 1-2 days for Stage III and every 12 hours for Stage IV. Delivery is ideal at Stage II as this resulted in the least number of acidosis and neonatal mortalities.
ABSTRACT
Fetal growth restriction is intimately linked to the placental function due to its failure of adequately nurture and oxygenate the fetus, with consequences in the short and long term. The search for the best definition and best diagnostic biomarkers has currently led to angiogenic factors closely related to the placenta formation and development. Placenta hypoperfusion has been linked to alterations in the levels of angiogenic factors, and it is proposed that these could help to differentiate the fetuses truly affected by chronic hypoxia even before the late adaptive hemodynamic changes are evident by Doppler ultrasound. This could have implications not only in the definition of growth restriction but also in the potential prediction of the event.
La restricción de crecimiento fetal está íntimamente ligada a la función placentaria por el fracaso de la adecuada nutrición y oxigenación del feto, con múltiples consecuencias a corto y largo plazo. La búsqueda de la mejor definición y de los mejores biomarcadores diagnósticos actualmente se dirige a los factores angiogénicos. Estos factores se relacionan estrechamente con la formación y desarrollo placentario. En la hipoperfusión placentaria se ha hallado alteraciones en los niveles de los factores angiogénicos, por lo que estos factores podrían ayudar a diferenciar a los fetos verdaderamente afectados por hipoxia crónica aún antes que los cambios hemodinámicos adaptativos tardíos sean evidenciables en la ultrasonografía Doppler. Esto podría tener implicancias no solo en la definición de restricción de crecimiento sino también en la potencial predicción del evento.
ABSTRACT
This study was designed to investigate a possible role for Doppler velocimetry as apredictor of uteroplacental insufficiency with fetal heart rate(FHR) tracing. From January1994 to through May 1996, we studied 419 high risk pregnant women who underwent Dopplervelocimetry within 1 week of intrapartum cardiotocogram or contraction stress test(CST) after 30 gestational weeks. The presence of a diastolic notch in uterine artery,elevated systolic/diastolic(S/D) ratios in umbilical artery(more than 3.0), or in uterine artery(more than 2.6) were considered abnormal. All of the 419 subjects were performed intrapartumcardiotocogram or CST within 1 week after Doppler veocimetry. Seventeen caseswere associated with persistent late deceleration or positive CST. The sensitivity, specificity,positive predictive value, negative predictive value, and relative risk of umbilical arteryS/D ratio for predicting abnormal FHR tracing were 23.5%(4/17), 89.3%(359/402), 8.5%(4/47), 96.5%(359/372), and 0.97. those of uterine artery S/D ratio and diastolic notch were29.4%(5/17), 92.5%(372/402), 14.3%(5/35), 96.9%(372/384), 1.35 and 35.3%(6/17), 90.3%(363/402), 13.3%(6/45), 97.6%(363/374), 3.88 respectively. The presence of uterine arterydiastolic notch in Doppler velocimetry seems to be a better predictor for abnormal FHRtracing after 30 weeks gestation than are S/D ratios in umbilical or uterine arteries.In conclusion, we can suggest that the presence of diastolic notch in uterine arteryDoppler velocimetry might be useful to predict the uteroplacental insufficiency after 30gestational weeks.