Early Term versus Term Delivery in the Management of Fetal Growth Restriction: A Comparison of Two Protocols

Joshua D. Dahlke; Hector Mendez-Figueroa; Lindsay Maggio; Catherine M. Albright; Suneet P. Chauhan; Katharine D. Wenstrom

doi:10.1055/s-0034-1396688

American Journal of Perinatology, Table of Contents

Am J Perinatol 2015; 32(06): 523-530
DOI: 10.1055/s-0034-1396688

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Early Term versus Term Delivery in the Management of Fetal Growth Restriction: A Comparison of Two Protocols

Joshua D. Dahlke

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Rhode Island

,

Hector Mendez-Figueroa

²Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, UT Health-University of Texas Medical School, Houston, Texas

,

Lindsay Maggio

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Rhode Island

,

Catherine M. Albright

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Rhode Island

,

Suneet P. Chauhan

²Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, UT Health-University of Texas Medical School, Houston, Texas

,

Katharine D. Wenstrom

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Rhode Island

› Author Affiliations

Abstract

Objective This study aims to compare two management protocols in pregnancies diagnosed with fetal growth restriction (FGR).

Study Design All singleton pregnancies diagnosed and managed with FGR at our institution during two protocol periods were analyzed. The early term protocol (January 2008–February 2010) specified delivery at 37^0/7 weeks if antenatal testing was reassuring, but did not specify the timing of delivery if umbilical artery (UA) Doppler systolic:diastolic (S:D) ratios were elevated (>95th percentile for gestational age [GA]). The term protocol (March 2010–July 2012) specified delivery at 39^0/7 weeks with normal S:D ratios and 37^0/7 weeks with elevated S:D ratios when antenatal testing was reassuring.

Results There were 228 and 312 women in the early term and term protocol, respectively, who met inclusion criteria. Compared with the early term group, the term group had an increased median GA at delivery (37.1 vs. 38.6%, p < 0.001), decreased deliveries less than 37^0/7 weeks (37 vs. 24%, p = 0.01) and decreased neonatal intensive care unit (NICU) admissions (38 vs. 28%, p = 0.02).

Conclusion A protocol specifying delivery at 39^0/7 weeks when UA S:D ratios are normal and delivery at 37^0/7 weeks when UA S:D ratios are elevated when other antenatal testing is reassuring in FGR: (1) prolonged gestation, (2) decreased preterm births, and (3) decreased NICU admissions.

Keywords

fetal growth restriction - intrauterine growth restriction - management - surveillance

Full Text

References

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