A pilot randomized controlled trial of two regimens of fetal surveillance for small-for-gestational-age fetuses with normal results of umbilical artery Doppler velocimetry☆,☆☆,★
Section snippets
Methods
The study was undertaken between March 1993 and July 1997 at National Women’s Hospital, a tertiary referral center in Auckland, New Zealand. The study was approved by the regional ethics committee. Pregnant women with singleton pregnancies who were outpatients were eligible for recruitment into the study if they met all the following criteria: ultrasonographic evidence suggestive of restricted fetal growth (abdominal circumference <10th percentile),14 a previous anatomic scan at <20 weeks’
Results
A total of 167 women were randomly assigned, 85 to the twice-weekly surveillance group and 82 to the fortnightly surveillance group. The women randomly assigned to twice-weekly surveillance were younger than the fortnightly surveillance group but they did not differ in other background characteristics (Table I).Empty Cell Twice-weekly monitoring (n = 82) Fortnightly monitoring (n = 85) Gestational age at consent (d, mean ± SD) 239 ± 13 241 ± 14 Umbilical artery resistance
Comment
As expected, this pilot randomized controlled trial of 2 regimens of fetal surveillance did not demonstrate any difference in neonatal morbidity between the 2 study groups. A much larger study (N = 3400) would be required to detect a difference in neonatal nursery admissions if such indeed exists. However, this study does provide important additional data to confirm that neonatal morbidity is low among SGA fetuses with normal results of Doppler velocimetric studies. There were no perinatal
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Cited by (85)
The role of the fetal biophysical profile in the management of fetal growth restriction
2022, American Journal of Obstetrics and GynecologyCitation Excerpt :A nonreactive NST is seen in 72% and 30% of early- and late-onset FGR, respectively, and only a normal BPP is validated to establish fetal well-being in this setting.16 It is critical to note that behavioral responses to deteriorating metabolic status occur independently of Doppler findings and gestational age,107–113 providing the opportunity for an abnormal BPP to detect fetal compromise not reflected by cardiovascular findings.29,38,114,115 Conversely, it is equally critical to consider that the Doppler findings provide information about the required surveillance interval, which is independent of the fetal growth percentile even when an NST is reactive or the BPP is normal or equivocal.
Fetal Growth and Stillbirth
2021, Obstetrics and Gynecology Clinics of North AmericaSociety for Maternal-Fetal Medicine Consult Series #52: Diagnosis and management of fetal growth restriction: (Replaces Clinical Guideline Number 3, April 2012)
2020, American Journal of Obstetrics and GynecologyDiagnosis and surveillance of late-onset fetal growth restriction
2018, American Journal of Obstetrics and GynecologyAn integrated approach to fetal growth restriction
2017, Best Practice and Research: Clinical Obstetrics and GynaecologyCitation Excerpt :We first briefly introduce the most widely proposed and/or used parameters for follow-up and then briefly discuss a proposal for a stage-based management. There is evidence from a randomized trial [57] that twice-a-week monitoring results in more inductions without any improvement in the perinatal outcomes than monitoring every 2 weeks. Thus, the standard of care for low-risk SGA would be to monitor every 2 weeks.
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Supported by grants from Auckland Healthcare, the Health Research Council of New Zealand, the Lottery Health Grants Board, and the Maurice and Phyllis Paykel Trust.
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Reprints not available from the authors.
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0002-9378/2000 $12.00 + 06/1/102711