RESUMEN
PURPOSE:To identify the antenatal variables predictive of neonatal outcome and to examine the relationship between biophysical score, multivessel Doppler ultrasound and fetal heart rate monitoring in fetal growth restriction (FGR). METHODS:We retrospectively analyzed the pregnancy and neonatal outcomes of 64 growth restricted fetuses delivered at less than 34 weeks of gestation at Samsung Medical Center, from May 2005 to May 2008. The result of Doppler velocimetry including umbilical artery, middle cerebral artery, and ductus venosus and biophysical score (BPS) and fetal heart rate (FHR) monitoring for each subject were reviewed. Adverse neonatal outcome was defined as bronchopulmonary dysplasia, periventricular leukomalacia, grade 3~4 intraventricular hemorrhage, grade 3~4 retinopathy of prematurity, necrotizing enterocolitis, neonatal sepsis, and perinatal mortality. We performed the univariate and multivariate analysis to determine which antenatal fetal surveillance test is the best to predict the adverse neonatal outcome in preterm FGR. We also assessed the degree of agreement of each antenatal test by the Cohens kappa test. RESULTS:By the univariate analysis, significant variables associated with adverse neonatal outcome were gestational age at delivery, oligohydramnios, and abnormal ductus venosus Doppler. However, in the multivariate analysis, gestational age at delivery and oligohydramnios remained as independent predictors of adverse neonatal outcome. Degree of agreement among the antenatal tests expressed by the Cohens kappa was only significant between BPS and FHR monitoring (kappa=0.303, P=0.019). CONCLUSION:Our data suggests that the timing of delivery of growth restricted fetuses less than 34 weeks of gestation should be determined by the gestational age and oligohydramnios, not by the one abnormal antenatal fetal surveillance result. We also confirmed that there are considerable amount of disagreements among BPS, mutivessel Doppler, and FHR monitoring.