Objectives There is limited data on which to base counselling in severe previable fetal growth restriction (FGR). Our aim is to investigate outcome in extremely preterm fetuses depending on the cause of FGR. Methods Retrospective database study in two tertiary fetal medicine centres 2008–2015. We included singleton pregnancies 22+0–25+6weeks, AC ≤3rd percentile. Data obtained from fetal medicine software (ASTRAIA) included structural fetal and placental anomalies, uterine and fetal Doppler and neonatal outcome. Causes at ultrasound diagnosis were uteroplacental insufficiency, evidence of intraplacental damage with normal uterine artery Doppler, viral infection or genetic/chromosomal. Statistical analysis was performed with SPSS. Results 101 cases with complete data were included. At diagnosis 70/101 (69.3%) were classed as uteroplacental; 7/101 (6.9%) as suspected intraplacental. There were no cases of suspected intrauterine infection. 16/101 (15.8%) were suspected genetic/chromosomal anomaly; 9/16 (56.3%) had proven genetic/chromosomal (5 Trisomy 18, 1 Trisomy 21, 1 Trisomy 13, balanced translocation, Russell Silver syndrome), 3/16 had normal genetic/chromosomal results and 4/16 were not tested. 5 cases were uncategorised antenatally. The overall rate of fetal demise was 57/101(56.4%) with 44 of these being in utero deaths or fetocides, including all cases with chromosomal abnormalities. One baby with Russell Silver syndrome died in infancy. Of 57 liveborn babies, 56 were born ≥24 weeks and 44 neonates survived: 7/13 (54%) at 24–28 weeks; 12/14 (86%) at 28–32 weeks, 8/10 (80%) at 32–36 weeks and 17/19 (94%) at 36–40 weeks. Conclusions Two-thirds of periviable FGR cases are associated with uteroplacental insufficiency/intraplacental damage. Just under 10% had chromosomal/genetic conditions: these were universally lethal. In uteroplacental insufficiency and intraplacental damage, survival is related to gestation at delivery, with outcomes better than might be assumed and some pregnancies reaching term.

Outcome in periviable fetal growth restriction / Dall'Asta, Andrea. - In: ULTRASOUND IN OBSTETRICS & GYNECOLOGY. - ISSN 0960-7692. - ELETTRONICO. - (2015). ((Intervento presentato al convegno 25th World Congress on Ultrasound in Obstetrics and Gynecology tenutosi a Montreal nel 11-14 Ottobre 2015.

Outcome in periviable fetal growth restriction.

Andrea Dall'Asta
Membro del Collaboration Group
2015

Abstract

Objectives There is limited data on which to base counselling in severe previable fetal growth restriction (FGR). Our aim is to investigate outcome in extremely preterm fetuses depending on the cause of FGR. Methods Retrospective database study in two tertiary fetal medicine centres 2008–2015. We included singleton pregnancies 22+0–25+6weeks, AC ≤3rd percentile. Data obtained from fetal medicine software (ASTRAIA) included structural fetal and placental anomalies, uterine and fetal Doppler and neonatal outcome. Causes at ultrasound diagnosis were uteroplacental insufficiency, evidence of intraplacental damage with normal uterine artery Doppler, viral infection or genetic/chromosomal. Statistical analysis was performed with SPSS. Results 101 cases with complete data were included. At diagnosis 70/101 (69.3%) were classed as uteroplacental; 7/101 (6.9%) as suspected intraplacental. There were no cases of suspected intrauterine infection. 16/101 (15.8%) were suspected genetic/chromosomal anomaly; 9/16 (56.3%) had proven genetic/chromosomal (5 Trisomy 18, 1 Trisomy 21, 1 Trisomy 13, balanced translocation, Russell Silver syndrome), 3/16 had normal genetic/chromosomal results and 4/16 were not tested. 5 cases were uncategorised antenatally. The overall rate of fetal demise was 57/101(56.4%) with 44 of these being in utero deaths or fetocides, including all cases with chromosomal abnormalities. One baby with Russell Silver syndrome died in infancy. Of 57 liveborn babies, 56 were born ≥24 weeks and 44 neonates survived: 7/13 (54%) at 24–28 weeks; 12/14 (86%) at 28–32 weeks, 8/10 (80%) at 32–36 weeks and 17/19 (94%) at 36–40 weeks. Conclusions Two-thirds of periviable FGR cases are associated with uteroplacental insufficiency/intraplacental damage. Just under 10% had chromosomal/genetic conditions: these were universally lethal. In uteroplacental insufficiency and intraplacental damage, survival is related to gestation at delivery, with outcomes better than might be assumed and some pregnancies reaching term.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11381/2857223
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