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

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    Authors
    O'Dwyer, Vicky
    Burke, Gerard
    Unterscheider, Julia
    Daly, Sean
    Geary, Michael P
    Kennelly, Mairead M
    McAuliffe, Fionnuala M
    O'Donoghue, Keelin
    Hunter, Alyson
    Morrison, John J
    Dicker, Patrick
    Tully, Elizabeth C
    Malone, Fergal D
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    Affiliation
    Department of Obstetrics and Gynecology, Royal College of Surgeons in Ireland. Electronic address: vickyodwyer@rcsi.ie.
    Issue Date
    2014-07-25
    
    Metadata
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    Citation
    Defining the residual risk of adverse perinatal outcome in growth restricted fetuses with normal umbilical artery blood flow. 2014: Am. J. Obstet. Gynecol.
    Publisher
    American journal of obstetrics and gynecology
    Journal
    American journal of obstetrics and gynecology
    URI
    http://hdl.handle.net/10147/324062
    DOI
    10.1016/j.ajog.2014.07.033
    PubMed ID
    25068564
    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.
    Item Type
    Article
    Language
    en
    ISSN
    1097-6868
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.ajog.2014.07.033
    Scopus Count
    Collections
    Royal College of Surgeons in Ireland (RCSI)

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