Timing of Delivery in Pregnancies Complicated by Suspected Fetal Growth Restriction without Doppler Abnormalities

Beth L. Pineles; Sarah Crimmins; Ozhan Turan

doi:10.1055/s-0039-1688470

American Journal of Perinatology, Table of Contents

Am J Perinatol 2020; 37(06): 647-651
DOI: 10.1055/s-0039-1688470

Original Article

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

Timing of Delivery in Pregnancies Complicated by Suspected Fetal Growth Restriction without Doppler Abnormalities

Beth L. Pineles

¹Department of Obstetrics and Gynecology and Reproductive Sciences, University of Maryland Medical Center, Baltimore, Maryland

,

Sarah Crimmins

¹Department of Obstetrics and Gynecology and Reproductive Sciences, University of Maryland Medical Center, Baltimore, Maryland

,

Ozhan Turan

¹Department of Obstetrics and Gynecology and Reproductive Sciences, University of Maryland Medical Center, Baltimore, Maryland

› Author Affiliations

Abstract

Objective This study aimed to identify the optimal gestational age for delivery of pregnancies complicated by fetal growth restriction (FGR) without Doppler abnormalities.

Study Design Cases of FGR (ultrasound-estimated fetal weight less than the 10th or abdominal circumference less than the 5th percentile for gestational age) without fetal Doppler abnormalities were identified from a fetal ultrasound database. The primary outcome was a composite of perinatal mortality and morbidity. The risk of the primary outcome for each gestational age was compared with pregnancies delivered at 39^0/7 to 40^6/7 weeks. Odds ratios were adjusted for potential confounders.

Results The analysis included 1,024 pregnancies. FGR was identified at a median of 23^5/7 weeks (range: 20–42 weeks). Four cases of fetal death (23^4/7—37^6/7 weeks) and no neonatal deaths were included. The primary outcome occurred in 209 patients (20.4%). This was greater for patients delivered at less than 37 weeks' gestation than for those delivered at or after 39 weeks' gestation, with no increased risk after 40 weeks.

Conclusion Among pregnancies complicated by suspected FGR without Doppler abnormalities, delivery at 39 weeks is safe with no difference in perinatal outcomes from 37 to 42 weeks.

Keywords

fetal death - fetal growth restriction - IUGR - stillbirth

Full Text

References

References
1 Stillbirth. In: Cunningham FG, Leveno KJ, Bloom SL. , et al., eds. Williams Obstetrics. Chap. 35. Vol. 24. United States: The McGraw-Hill Companies, Inc.; 2010: 661-667
2 Figueras F, Caradeux J, Crispi F, Eixarch E, Peguero A, Gratacos E. Diagnosis and surveillance of late-onset fetal growth restriction. Am J Obstet Gynecol 2018; 218 (2S): S790-S802
3 American College of Obstetricians and Gynecologists. ACOG committee opinion no. 561: nonmedically indicated early-term deliveries. Obstet Gynecol 2013; 121 (04) 911-915
4 Paz Levy D, Sheiner E, Wainstock T, Sergienko R, Landau D, Walfisch A. Evidence that children born at early term (37-38 6/7 weeks) are at increased risk for diabetes and obesity-related disorders. Am J Obstet Gynecol 2017; 217 (05) 588.e1-588.e11
5 Unterscheider J, Daly S, O'Donoghue K, Malone FD. ; Perinatal Ireland Research Consortium. Critical umbilical artery Doppler abnormalities in early fetal growth restriction and the timing of delivery: an overestimated clinical challenge in daily obstetric practice?. Ultrasound Obstet Gynecol 2014; 43 (02) 236-237
6 Boers KE, Vijgen SM, Bijlenga D. , et al; DIGITAT study group. Induction versus expectant monitoring for intrauterine growth restriction at term: randomised equivalence trial (DIGITAT). BMJ 2010; 341: c7087
7 Baschat AA, Gembruch U, Reiss I, Gortner L, Weiner CP, Harman CR. Relationship between arterial and venous Doppler and perinatal outcome in fetal growth restriction. Ultrasound Obstet Gynecol 2000; 16 (05) 407-413
8 Trudell AS, Cahill AG, Tuuli MG, Macones GA, Odibo AO. Risk of stillbirth after 37 weeks in pregnancies complicated by small-for-gestational-age fetuses. Am J Obstet Gynecol 2013; 208 (05) 376.e1-376.e7
9 Boers KE, van Wyk L, van der Post JA. , et al; DIGITAT Study Group. Neonatal morbidity after induction vs expectant monitoring in intrauterine growth restriction at term: a subanalysis of the DIGITAT RCT. Am J Obstet Gynecol 2012; 206 (04) 344.e1-344.e7
10 Madden JV, Flatley CJ, Kumar S. Term small-for-gestational-age infants from low-risk women are at significantly greater risk of adverse neonatal outcomes. Am J Obstet Gynecol 2018; 218 (05) 525.e1-525.e9
11 Wingate MS, Smith RA, Petrini JR, Barfield WD. Disparities in gestational age-specific fetal mortality rates in the United States, 2009-2013. Ann Epidemiol 2017; 27 (09) 570-574
12 Buck Louis GM, Grewal J, Albert PS. , et al. Racial/ethnic standards for fetal growth: the NICHD Fetal Growth Studies. Am J Obstet Gynecol 2015; 213 (04) 449.e1-449.e41
13 Tarca AL, Romero R, Gudicha DW. , et al. A new customized fetal growth standard for African American women: the PRB/NICHD Detroit study. Am J Obstet Gynecol 2018; 218 (2S): S679-S691
14 Papageorghiou AT, Ohuma EO, Altman DG. , et al; International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st). International standards for fetal growth based on serial ultrasound measurements: the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project. Lancet 2014; 384 (9946): 869-879
15 Sovio U, Smith GCS. The effect of customization and use of a fetal growth standard on the association between birthweight percentile and adverse perinatal outcome. Am J Obstet Gynecol 2018; 218 (2S): S738-S744
16 American College of Obstetricians and Gynecologists. ACOG committee opinion no. 560: medically indicated late-preterm and early-term deliveries. Obstet Gynecol 2013; 121 (04) 908-910