Predicting Perinatal Mortality in Preterm Intrauterine Growth Restriction

 

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ABSTRACT

We evaluated if maternal demographic and ultrasound parameters predict perinatal mortality in preterm intrauterine growth restriction (IUGR). Retrospective cohort study of preterm IUGR (delivery gestational age <35 weeks and birth weight <10th percentile for gestation). We excluded twins and fetuses with aneuploidy, intrauterine infection, or major congenital malformations. Information collected included maternal demographic and medical information, estimated fetal weight, oligohydramnios (amniotic fluid index <5), abnormal umbilical artery Dopplers (absent or reverse end-diastolic flow), and abnormal biophysical score (score <6). Our outcome was perinatal mortality, which was defined as in utero death or neonatal death within the first 28 days of life. Statistical analysis included bivariate and multivariable techniques as well as receiver operator characteristic analysis. Two hundred thirty singleton pregnancies with preterm IUGR meeting the inclusion criteria were identified. Variables associated with perinatal mortality included oligohydramnios and abnormal umbilical artery Dopplers. These two variables had modest predictive value for perinatal mortality. In cases of preterm IUGR, only the presence of abnormal umbilical artery Dopplers or oligohydramnios predicts perinatal mortality.

REFERENCES

• 1 Resnick R. Intrauterine growth restriction.  Obstet Gynecol. 2002;  99 490-496
  CrossrefPubMedGoogle Scholar
• 2 Bernstein I M, Horbar J D, Badger G J, Ohlsson A, Golan A. Morbidity and mortality among very-low-birth-weight neonates with intrauterine growth restriction. The Vermont Oxford Network.  Am J Obstet Gynecol. 2000;  182 198-206
  CrossrefPubMedGoogle Scholar
• 3 Zeitlin J, Ancel P Y, Saurel-Cubizolles M J, Papiernik E. The relationship between intrauterine growth restriction and preterm delivery: an empirical approach using data from a European case-control study.  BJOG. 2000;  107 750-758
  CrossrefPubMedGoogle Scholar
• 4 Garite T J, Clark R, Thorp J A. Intrauterine growth restriction increases morbidity and mortality among premature neonates.  Am J Obstet Gynecol. 2004;  191 481-487
  CrossrefPubMedGoogle Scholar
• 5 Alfirevic Z, Neilson J P. Doppler ultrasonography in high-risk pregnancies: systematic review with meta-analysis.  Am J Obstet Gynecol. 1995;  172 1379-1387
  CrossrefPubMedGoogle Scholar
• 6 Alexander G R, Hines J H, Kaufman R B, Mor J, Kogan M. A United States National Reference for fetal growth.  Obstet Gynecol. 1996;  87 163-168
  CrossrefPubMedGoogle Scholar
• 7 Craigo S D, Beach M L, Harvey-Wilkes K B, D'Alton M E. Ultrasound predictors of neonatal outcome in intrauterine growth restriction.  Am J Perinatol. 1996;  13 465-471
  Article in Thieme ConnectPubMedGoogle Scholar
• 8 Karsdorp V H, van Vugt J M, van Geijn H P et al.. Clinical significance of absent or reversed end diastolic velocity waveforms in umbilical artery.  Lancet. 1994;  344 1664-1668
  CrossrefPubMedGoogle Scholar
• 9 Baschat A A, Gembruch U, Reiss I, Gortner L, Weiner C P, Harman C R. Relationship between arterial and venous Doppler and perinatal outcome in fetal growth restriction.  Ultrasound Obstet Gynecol. 2000;  16 407-413
  CrossrefPubMedGoogle Scholar
• 10 Baschat A A, Gembruch U, Harman C R. The sequence of changes in Doppler and biophysical parameters as severe fetal growth restriction worsens.  Ultrasound Obstet Gynecol. 2001;  18 571-577
  CrossrefPubMedGoogle Scholar
• 11 Baschat A A, Cosmi E, Bilardo C M et al.. Predictors of neonatal outcome in early onset placental dysfunction.  Obstet Gynecol. 2007;  109 253-261
  CrossrefPubMedGoogle Scholar
• 12 McIntire D D, Bloom S L, Casey B M, Leveno K J. Birth weight in relation to morbidity and mortality among newborn infants.  N Engl J Med. 1999;  340 1234-1238
  CrossrefPubMedGoogle Scholar
• 13 Rutherford S E, Phelan J P, Smith C V, Jacobs N. The four quadrant assessment of amniotic fluid volume: an adjunct to antepartum fetal heart rate testing.  Obstet Gynecol. 1987;  70 353-356
  PubMedGoogle Scholar
• 14 Moore T R, Cayle J E. The amniotic fluid index in normal human pregnancy.  Am J Obstet Gynecol. 1990;  162 1168-1173
  CrossrefPubMedGoogle Scholar
• 15 Johnson J M, Chauhan S P, Emmen C S et al.. A comparison of 3 criteria of oligohydramnios identifying peripartum complications: a secondary analysis.  Am J Obstet Gynecol. 2007;  197 207-212
  PubMedGoogle Scholar
• 16 GRIT Study Group . A randomized trial of timed delivery for the compromised preterm fetus: short term outcomes and Bayesian interpretation.  BJOG. 2003;  110 27-32
  PubMedGoogle Scholar
• 17 Thornton J G, Hornbuckle J, Vail A, Spiegenhalter D J, Levene M. Infant wellbeing at 2 years of age in the Growth Restriction Intervention Trial (GRIT): multicentered randomized controlled trial.  Lancet. 2004;  364 513-520
  CrossrefPubMedGoogle Scholar

Christina M ScifresM.D. 

Washington University School of Medicine, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine

4911 Barnes Jewish Hospital Plaza, Box 8064, St. Louis, Missouri 63110

Email: scifresc@wudosis.wustl.edu