Perinatal outcome of stage-based management of fetal growth restriction in a government tertiary care hospital in Kerala, India
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20212175Keywords:
FGR, Small for gestational age, Ultrasound and Doppler, Perinatal outcomeAbstract
BACKGROUND: Fetal Growth Restriction (FGR) is the largest contributing factor to perinatal morbidity, mortality and impaired neurodevelopment. This research strives to elucidate the perinatal outcomes of stage based management of fetal growth restriction using Obstetric Doppler and its association with maternal sociodemographic profile.
METHODS: The research was conducted among 320 antenatal women whose Estimated Fetal weight was <10th centile. Periodic follow up with Doppler was done and managed as per the stage of FGR. Perinatal outcomes were compiled.
RESULTS: The incidence of FGR in T.D Medical College, Alappuzha was 15.23%. SGA accounted for 47 %. The proportion of early and late onset FGR was 10.3% & 89.7% respectively. 57.18% of the newborns were admitted to NICU. The common complications were: Low birth weight – 47.8% ARDS – 21% , Sepsis – 9.6%, Necrotizing enterocolitis – 4%, Hyperbilirubinemia – 4.9%. The incidence of Neonatal death and stillbirth were 1.56% and 0.3% respectively. Mothers who were underweight, inadequate weight gain during pregnancy and short inter pregnancy interval had increased risks. Hypertensive disorders of pregnancy was the commonly associated medical condition.
CONCLUSION: Prolongation of pregnancy even by one day results in 2% increased chances of survival of the newborn. Hence, it becomes imperative to identify the benign forms of FGR to prevent iatrogenic prematurity. Antenatal women should be screened for risk factors and undergo vigilant antepartum surveillance to bring about favourable perinatal outcome.
References
Mureșan D, Rotar IC, Stamatian F. The usefulness of fetal Doppler evaluation in early versus late onset intrauterine growth restriction. Review of the literature. Med Ultrason. 2016;18(1):103-9.
Cohen E, Baerts W, van Bel F. Brain-Sparing in Intrauterine Growth Restriction: Considerations for the Neonatologist. Neonatology. 2015;108(4):269-76.
Meher S, Hernandez-Andrade E, Basheer SN, Lees C. Impact of cerebral redistribution on neurodevelopmental outcome in small-for-gestational-age or growth-restricted babies: a systematic review. Ultrasound Obstet Gynecol. 2015;46(4):398-404.
Figueras F, Gratacós E. Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol. Fetal Diagn Ther. 2014;36(2):86-98.
Senat MV, Tsatsaris V. Prenatal management of isolated IUGR. J Gynecol Obstet Biol Reprod (Paris). 2013;42(8):941-65.
Perrotin F, Simon EG, Potin J, Laffon M. Delivery of the IUGR fetus. J Gynecol Obstet Biol Reprod (Paris). 2013;42(8):975-84.
Salomon LJ, Malan V. Managing and identifying the causes of IUGR. J Gynecol Obstet Biol Reprod (Paris). 2013;42(8):929-40.
Flamant C, Gascoin G. Short-term outcome and small for gestational age newborn management. J Gynecol Obstet Biol Reprod (Paris). 2013;42(8):985-95.
Unterscheider J, O’Donoghue K, Daly S, Geary MP, Kennelly MM, McAuliffe FM et al. Fetal growth restriction and the risk of perinatal mortality-case studies from the multi-centre PORTO study. BMC Preg Childbirth. 2014;14(1):63.
Fetal growth disorders. In Williams Obstetrics. 25th ed. New York, NY: Mc Graw Hill. 2013:872-90.
Buck Louis GM, Grewal J, Albert PS. Racial/ethnic standards for fetal growth: the NICHD Fetal Growth Studies. Am J Obstet Gynecol. 2015;213:449.e1.
Unterscheider J, Daly S, Geary MP. Optimizing the definition of intrauterine growth restriction: the multicenter prospective PORTO Study. Am J Obstet Gynecol. 2013;208:290.e1.
Mlynarczyk M, Chauhan SP, Baydoun HA. The clinical significance of an estimated fetal weight below the 10th percentile: a comparison of outcomes of <5th vs 5th-9th percentile. Am J Obstet Gynecol. 2017;217:198.e1.
Barker ED, McAuliffe FM, Alderdice F. The role of growth trajectories in classifying fetal growth restriction. Obstet Gynecol. 2013;122:248.
Gardosi J. New definition of small for gestational age based on fetal growth potential. Horm Res. 2006;65(3):15.
Gardosi J, Figueras F, Clausson B, Francis A. The customised growth potential: an international research tool to study the epidemiology of fetal growth. Paediatr Perinat Epidemiol. 2011;25:2.
Figueras F, Gardosi J. Intrauterine growth restriction: new concepts in antenatal surveillance, diagnosis, and management. Am J Obstet Gynecol. 2011;204:288.
Mateus J, Newman RB, Zhang C. Fetal Growth Patterns in Pregnancy-Associated Hypertensive Disorders: NICHD Fetal Growth Studies. Am J Obstet Gynecol. 2019.
Mendez H. Introduction to the study of pre- and post-natal growth in humans: a review. Am J Med Genet. 1985;20:63.
Khoury MJ, Erickson JD, Cordero JF, McCarthy BJ. Congenital malformations and intrauterine growth retardation: a population study. Pediatrics. 1988;82:83.
Gülmezoglu AM, Hofmeyr GJ. Betamimetics for suspected impaired fetal growth. Cochrane Database Syst Rev. 2001;CD000036.
Morris RK, Malin G, Robson SC. Fetal umbilical artery Doppler to predict compromise of fetal/neonatal wellbeing in a high-risk population: systematic review and bivariate meta-analysis. Ultrasound Obstet Gynecol. 2011;37:135.
Fanaroff AA, Hack M, Walsh MC. The NICHD neonatal research network: changes in practice and outcomes during the first 15 years. Semin Perinatol. 2003;27(4):281-7.
De Onis M, Blossner M, Villar J. Levels and patterns of intrauterine growth retardation in developing countries. Eur J Clin Nutr. 1998;52(1):S5-S15.
Chandra S, Mathews SC. Perinatal morbidity and mortality in low birthweight babies. J Obstet Gynaecol India. 2003:53(3):237.
Shenoy HT, James SX, Shenoy ST. Maternal risk factors and perinatal outcomes in fetal growth restriction using obstetric Doppler in South Kerala, India. Int J Reprod Contracept Obstet Gynecol. 2019;8(1):6-13.
Singh A, Ambujam K. Maternal socio-demographic determinants and fetal outcome of intrauterine growth restriction. Int J Reprod Contracept Obstet Gynecol. 2018;7:3843-7.
Satyavrathan V, Ahmed N, Sundrappa S. Study of perinatal outcomes of pregnancies with intrauterine growth restriction in a tertiary care centre in North Kerala. J Evid Based Med Healthc. 2017;4(37):2203-8.
Seal A, Dasgupta A, Sengupta M, Dastider R, Sen S. Analysis of fetal growth restriction in pregnancy in subjects attending in an obstetric clinic of a tertiary care teaching hospital. Int J Reprod Contracept Obstet Gynecol. 2018;7:973-80.
Rutherford SE, Phelan JP, Smith CV, Jacobs N. The four-quadrant assessment of amniotic fluid volume: an adjunct to antepartum fetal heart rate testing. Obstet Gynecol. 1987;70(3 Pt 1):353-6.
Manning FA, Harman CR, Morrison I, Menticoglou SM, Lange IR, Johnson JM. Fetal assessment based on fetal biophysical profile scoring. IV. An analysis of perinatal morbidity and mortality. Am J Obstet Gynecol. 1990;162(3):703-9.
Cosmi E, Ambrosini G, D'antona D, Saccardi C, Mari G. Doppler, cardiotocography, and biophysical profile changes in growth restricted fetuses. Obstet Gynecol. 2005;106:1240-5.
Turan OM, Turan S, Gungor S, Berg C, Moyano D, Gembruch U et al. Progression of Doppler abnormalities in intrauterine growth restriction. Ultrasound Obstet Gynecol. 2008;32:160-7.
Cochran WD, Lee KG. Assessment of the new-born. Manual of Neonatal Care. 5th ed. Philadelphia: Lippincott Williams and Wilkins. 2004.
Ghazi HA, Spielberger C, Kallen B. Delivery outcome after infertility: a registry study. Fertil Steril. 1991;55:726-32.
Motghare DD, Frederick SV, Pawaskar M, Kulkarni. Maternal determinants of intrauterine growth restriction in Goa, India: a case-control study. Global J Medic Public Health. 2014;3(1):08.
Bassetty KC, Phukan P, Ahmed RD, Borah R. Outcomes of Neonates in Pregnancies with Intrauterine Growth Restriction in Developing Countries: A Cross-sectional Study Over a Period of 6 Months. Gynecol Obstet (Sunnyvale). 2017;7:434.
