Defining the residual risk of adverse perinatal outcome in growth restricted fetuses with normal umbilical artery blood flow.

Abstract

To determine the cause of adverse perinatal outcome in fetal growth restriction(FGR) where umbilical artery Doppler(UA) was normal, as identified from the Prospective Observational Trial to Optimize Pediatric Health(PORTO). We compared cases of adverse outcome where UA Doppler was normal and abnormal.

The PORTO study was a national multicenter study of >1,100 ultrasound-dated singleton pregnancies with an estimated fetal weight(EFW) <10th centile. Each pregnancy underwent intensive ultrasound, including multi-vessel Doppler. UA Doppler was considered abnormal when the pulsatility index was >95th centile or end-diastolic flow was absent/reversed. Adverse perinatal outcome was defined as a composite of intraventricular hemorrhage, periventricular leukomalacia, hypoxic ischemic encephalopathy, necrotizing enterocolitis, bronchopulmonary dysplasia, sepsis or death.

Fifty-seven(5.0%) of the 1,116 fetuses had an adverse perinatal outcome. Nine(1.3%) of 698 fetuses with normal UA Doppler had an adverse outcome, compared with 48(11.5%) of 418 with abnormal UA Doppler(p<0.0001). There were two perinatal deaths in the normal group and six in the abnormal group(p=0.01). The perinatal deaths in the normal group were one case of pulmonary hypoplasia after prolonged preterm rupture of the membranes from 12 weeks' gestation and a case of placental abruption. Gestation at delivery was 33±3 vs. 31±4 weeks(p=0.05) and mean birth-weight was 1830g±737 vs. 1146g±508 (p=0.001) in the respective groups. Neonatal sepsis was commonest adverse outcome in both groups, 0.1% and 0.4% respectively(p=0.01).

Adverse perinatal outcome is uncommon in FGR with normal UA Doppler. The cases we identified were associated with heterogenous pathologies. FGR with normal UA blood flow is a largely benign condition.