Fetal growth restriction and the risk of perinatal mortality: case studies from the multicentre PORTO study

Hdl Handle:
http://hdl.handle.net/10147/313003
Title:
Fetal growth restriction and the risk of perinatal mortality: case studies from the multicentre PORTO study
Authors:
Unterscheider, Julia; O’Donoghue, Keelin; Daly, Sean; Geary, Michael P; Kennelly, Mairead M; McAuliffe, Fionnuala M; Hunter, Alyson; Morrison, John J; Burke, Gerard; Dicker, Patrick; Tully, Elizabeth C; Malone, Fergal D
Citation:
BMC Pregnancy and Childbirth. 2014 Feb 11;14(1):63
Issue Date:
11-Feb-2014
URI:
http://dx.doi.org/10.1186/1471-2393-14-63; http://hdl.handle.net/10147/313003
Abstract:
Abstract Background Intrauterine growth restriction (IUGR) is the single largest contributing factor to perinatal mortality in non-anomalous fetuses. Advances in antenatal and neonatal critical care have resulted in a reduction in neonatal deaths over the past decades, while stillbirth rates have remained unchanged. Antenatal detection rates of fetal growth failure are low, and these pregnancies carry a high risk of perinatal death. Methods The Prospective Observational Trial to Optimize Paediatric Health in IUGR (PORTO) Study recruited 1,200 ultrasound-dated singleton IUGR pregnancies, defined as EFW <10th centile, between 24+0 and 36+6 weeks gestation. All recruited fetuses underwent serial sonographic assessment of fetal weight and multi-vessel Doppler studies until birth. Perinatal outcomes were recorded for all pregnancies. Case records of the perinatal deaths from this prospectively recruited IUGR cohort were reviewed, their pregnancy details and outcome were analysed descriptively and compared to the entire cohort. Results Of 1,116 non-anomalous singleton infants with EFW <10th centile, 6 resulted in perinatal deaths including 3 stillbirths and 3 early neonatal deaths. Perinatal deaths occurred between 24+6 and 35+0 weeks gestation corresponding to birthweights ranging from 460 to 2260 grams. Perinatal deaths occurred more commonly in pregnancies with severe growth restriction (EFW <3rd centile) and associated abnormal Doppler findings resulting in earlier gestational ages at delivery and lower birthweights. All of the described pregnancies were complicated by either significant maternal comorbidities, e.g. hypertension, systemic lupus erythematosus (SLE) or diabetes, or poor obstetric histories, e.g. prior perinatal death, mid-trimester or recurrent pregnancy loss. Five of the 6 mortalities occurred in women of non-Irish ethnic backgrounds. All perinatal deaths showed abnormalities on placental histopathological evaluation. Conclusions The PNMR in this cohort of prenatally identified IUGR cases was 5.4/1,000 and compares favourably to the overall national rate of 4.1/1,000 births, which can be attributed to increased surveillance and timely delivery. Despite antenatal recognition of IUGR and associated maternal risk factors, not all perinatal deaths can be prevented.
Item Type:
Article
Language:
en
Keywords:
PERINATAL MORTALITY
Local subject classification:
FETAL GROWTH

Full metadata record

DC FieldValue Language
dc.contributor.authorUnterscheider, Juliaen_GB
dc.contributor.authorO’Donoghue, Keelinen_GB
dc.contributor.authorDaly, Seanen_GB
dc.contributor.authorGeary, Michael Pen_GB
dc.contributor.authorKennelly, Mairead Men_GB
dc.contributor.authorMcAuliffe, Fionnuala Men_GB
dc.contributor.authorHunter, Alysonen_GB
dc.contributor.authorMorrison, John Jen_GB
dc.contributor.authorBurke, Gerarden_GB
dc.contributor.authorDicker, Patricken_GB
dc.contributor.authorTully, Elizabeth Cen_GB
dc.contributor.authorMalone, Fergal Den_GB
dc.date.accessioned2014-02-17T15:33:08Z-
dc.date.available2014-02-17T15:33:08Z-
dc.date.issued2014-02-11-
dc.identifier.citationBMC Pregnancy and Childbirth. 2014 Feb 11;14(1):63en_GB
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2393-14-63-
dc.identifier.urihttp://hdl.handle.net/10147/313003-
dc.description.abstractAbstract Background Intrauterine growth restriction (IUGR) is the single largest contributing factor to perinatal mortality in non-anomalous fetuses. Advances in antenatal and neonatal critical care have resulted in a reduction in neonatal deaths over the past decades, while stillbirth rates have remained unchanged. Antenatal detection rates of fetal growth failure are low, and these pregnancies carry a high risk of perinatal death. Methods The Prospective Observational Trial to Optimize Paediatric Health in IUGR (PORTO) Study recruited 1,200 ultrasound-dated singleton IUGR pregnancies, defined as EFW <10th centile, between 24+0 and 36+6 weeks gestation. All recruited fetuses underwent serial sonographic assessment of fetal weight and multi-vessel Doppler studies until birth. Perinatal outcomes were recorded for all pregnancies. Case records of the perinatal deaths from this prospectively recruited IUGR cohort were reviewed, their pregnancy details and outcome were analysed descriptively and compared to the entire cohort. Results Of 1,116 non-anomalous singleton infants with EFW <10th centile, 6 resulted in perinatal deaths including 3 stillbirths and 3 early neonatal deaths. Perinatal deaths occurred between 24+6 and 35+0 weeks gestation corresponding to birthweights ranging from 460 to 2260 grams. Perinatal deaths occurred more commonly in pregnancies with severe growth restriction (EFW <3rd centile) and associated abnormal Doppler findings resulting in earlier gestational ages at delivery and lower birthweights. All of the described pregnancies were complicated by either significant maternal comorbidities, e.g. hypertension, systemic lupus erythematosus (SLE) or diabetes, or poor obstetric histories, e.g. prior perinatal death, mid-trimester or recurrent pregnancy loss. Five of the 6 mortalities occurred in women of non-Irish ethnic backgrounds. All perinatal deaths showed abnormalities on placental histopathological evaluation. Conclusions The PNMR in this cohort of prenatally identified IUGR cases was 5.4/1,000 and compares favourably to the overall national rate of 4.1/1,000 births, which can be attributed to increased surveillance and timely delivery. Despite antenatal recognition of IUGR and associated maternal risk factors, not all perinatal deaths can be prevented.-
dc.language.isoenen
dc.subjectPERINATAL MORTALITYen_GB
dc.subject.otherFETAL GROWTHen_GB
dc.titleFetal growth restriction and the risk of perinatal mortality: case studies from the multicentre PORTO studyen_GB
dc.typeArticleen
dc.language.rfc3066en-
dc.rights.holderJulia Unterscheider et al.; licensee BioMed Central Ltd.-
dc.description.statusPeer Reviewed-
dc.date.updated2014-02-14T00:01:13Z-
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