Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Acta Obstet Gynecol Scand. 2021 Aug;100(8):1430-1438. doi: 10.1111/aogs.14142. Epub 2021 Mar 29.
Early-onset fetal growth restriction is a pregnancy complication often coinciding with abnormal Doppler flow in the umbilical artery. Absent or reversed end-diastolic flow in the umbilical artery is associated with adverse perinatal outcome. As the optimal management of this condition is unclear, the objective of this study was to analyze the time interval from admission to delivery of pregnancies with early-onset fetal growth restriction, while pursuing a policy of postponing delivery unless active management of labor would be required because of fetal distress or maternal condition. We also assessed short- and long-term perinatal outcome.
In this historical cohort study, all pregnant women with singleton pregnancies, admitted during 2004-2015 with early-onset fetal growth restriction were included. Pregnancies with absent or reversed end-diastolic flow (AREDF) were compared with pregnancies with a positive end-diastolic Doppler flow (PEDF). Time until delivery was determined and perinatal outcome was assessed for both groups.
In our study, 111 women were allocated to the PEDF group and 109 to the AREDF group. In the AREDF group, fetal distress was more often an indication for delivery, in comparison with the PEDF group (p = .004). Median time until delivery in patients admitted between 26 and 28 weeks' gestation was 6+5 weeks in the PEDF group and 1+4 weeks in the AREDF group (p = .001). No statistically significant difference was found between the Doppler groups in the composite adverse neonatal outcome, which includes at least one of the following outcomes: infant respiratory distress syndrome, sepsis, bronchopulmonary dysplasia, necrotizing enterocolitis, intraventricular hemorrhage >grade 2, periventricular leukomalacia and perinatal death (p = .63).
In this study, comprising pregnancies with early-onset fetal growth restriction, fetal distress was observed more frequently in the AREDF group with the consequence of delivery at an earlier stage of gestation, compared with the PEDF group. AREDF was not associated with increased perinatal morbidity and mortality compared with PEDF.
早期胎儿生长受限是一种妊娠并发症，常伴有脐动脉多普勒血流异常。脐动脉无舒张末期血流或反向舒张末期血流与不良围产儿结局相关。由于这种情况的最佳处理方法尚不清楚，本研究的目的是分析早期胎儿生长受限孕妇入院至分娩的时间间隔，同时在需要因胎儿窘迫或母亲状况而主动分娩管理之前，推迟分娩。我们还评估了短期和长期围产儿结局。
在这项历史性队列研究中，所有在 2004 年至 2015 年期间因早期胎儿生长受限入院的单胎妊娠孕妇均被纳入研究。将无舒张末期血流（AREDF）的妊娠与有正性舒张末期多普勒血流（PEDF）的妊娠进行比较。确定两组的分娩时间，并评估围产儿结局。
在本研究中，111 名孕妇被分配到 PEDF 组，109 名孕妇被分配到 AREDF 组。在 AREDF 组中，与 PEDF 组相比，胎儿窘迫更常成为分娩的指征（p=0.004）。在 26-28 周入院的患者中，PEDF 组的中位分娩时间为 6+5 周，AREDF 组为 1+4 周（p=0.001）。在复合不良新生儿结局方面，即包括以下至少一种结局的情况：婴儿呼吸窘迫综合征、败血症、支气管肺发育不良、坏死性小肠结肠炎、脑室内出血≥2 级、脑室周围白质软化和围产儿死亡，PEDF 组和 AREDF 组之间无统计学差异（p=0.63）。
在这项包括早期胎儿生长受限妊娠的研究中，与 PEDF 组相比，AREDF 组观察到胎儿窘迫更频繁，导致更早的分娩阶段。与 PEDF 相比，AREDF 并不与围产儿发病率和死亡率增加相关。
