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Perinatal outcomes of early and late onset intrauterine growth retardation

Year 2020, Volume: 45 Issue: 4, 1758 - 1767, 27.12.2020
https://doi.org/10.17826/cumj.839861

Abstract

Purpose: The aim of this study was to show the effect of early and late onset intrauterine growth retardation (IUGR) on perinatal outcomes and the differences between them
Materials and Methods: Our study is a retrospective study. 334 patients who were followed up with the diagnosis of IUGR between January 1, 2015 and January 1, 2019 were divided into subgroups as early and late onset IUGR. The type of growth retardation, the gestational week at diagnosis, the estimated fetal weight (EFW), the presence of preeclampsia, doppler findings, the birth weight, the delivery type, the birth week, the 5th minute Apgar score, the neonatal intensive care need were recorded and the relationship of all these parameters with the negative consequences of the newborn was discussed.
Results: The average of the gestational week at diagnosis was 30.9 ± 4.5 (min-max: 18-39). The average of the gestational week at delivery was 34.4 ± 4.5 (min-max: 22-41). The patients were examined in four groups as <27 + 6, 28-31, 32-36,> 37 weeks according to the diagnosis time. Perinatal outcomes deteriorate with the severity of Doppler findings. Having EFW <3% percentil and early onset IUGR negatively affects the perinatal outcomes of fetuses.
Conclusion: Late onset preeclampsia does not adversely affect the perinatal outcomes of fetuses with IUGR, but early onset preeclampsia causes an increase in neonatal morbidity and mortality. For this reason, patients with early onset IUGR accompanied by early-onset preeclampsia should be followed more closely and be aware of perinatal morbidity and mortality.

References

  • 1. Unterscheider J, Daly S, Geary MP, Kennelly MM, McAuliffe FM, O'Donoghue K, et al. Optimizing the definition of intrauterine growth restriction: the multicenter prospective PORTO Study. Am J Obstet Gynecol. 2013;208(4):290.e1-6.
  • 2. Olsen IE, Groveman SA, Lawson ML, Clark RH, Zemel BS. New intrauterine growth curves based on United States data. Pediatrics. 2010;125(2):e214-24.
  • 3. Odibo AO, Francis A, Cahill AG, Macones GA, Crane JP, Gardosi J. Association between pregnancy complications and small-for-gestational-age birth weight defined by customized fetal growth standard versus a population-based standard. J Matern Fetal Neonatal Med. 2011;24(3):411-7.
  • 4. Buck Louis GM, Grewal J, Albert PS, Sciscione A, Wing DA, Grobman WA, et al. Racial/ethnic standards for fetal growth: the NICHD Fetal Growth Studies. Am J Obstet Gynecol. 2015;213(4):449.e1-.e41.
  • 5. Barker ED, McAuliffe FM, Alderdice F, Unterscheider J, Daly S, Geary MP, et al. The role of growth trajectories in classifying fetal growth restriction. Obstet Gynecol. 2013;122(2 Pt 1):248-54.
  • 6. Chappell LC, Enye S, Seed P, Briley AL, Poston L, Shennan AH. Adverse perinatal outcomes and risk factors for preeclampsia in women with chronic hypertension: a prospective study. Hypertension. 2008;51(4):1002-9.
  • 7. Aagaard-Tillery KM, Porter TF, Lane RH, Varner MW, Lacoursiere DY. In utero tobacco exposure is associated with modified effects of maternal factors on fetal growth. Am J Obstet Gynecol. 2008;198(1):66.e1-6.
  • 8. Strandberg-Larsen K, Tinggaard M, Nybo Andersen AM, Olsen J, Grønbaek M. Use of nicotine replacement therapy during pregnancy and stillbirth: a cohort study. Bjog. 2008;115(11):1405-10.
  • 9. Selling KE, Carstensen J, Finnström O, Sydsjö G. Intergenerational effects of preterm birth and reduced intrauterine growth: a population-based study of Swedish mother-offspring pairs. Bjog. 2006;113(4):430-40.
  • 10. Arduini D, Rizzo G, Caforio L, Boccolini MR, Romanini C, Mancuso S. Behavioural state transitions in healthy and growth retarded fetuses. Early Hum Dev. 1989;19(3):155-65.
  • 11. Simon NV, O'Connor TJ, 3rd, Shearer DM. Detection of intrauterine fetal growth retardation with abdominal circumference and estimated fetal weight using cross-sectional growth curves. J Clin Ultrasound. 1990;18(9):685-90.
  • 12. Melekoglu R, Yilmaz E, Yasar S, Hatipoglu I, Kahveci B, Sucu M. The ability of various cerebroplacental ratio thresholds to predict adverse neonatal outcomes in term fetuses exhibiting late-onset fetal growth restriction. J Perinat Med. 2020; doi: 10.1515/jpm-2020-0244 (in press).
  • 13. Gaudineau A. [Prevalence, risk factors, maternal and fetal morbidity and mortality of intrauterine growth restriction and small-for-gestational age]. J Gynecol Obstet Biol Reprod (Paris). 2013;42(8):895-910.
  • 14. Lieberman E, Gremy I, Lang JM, Cohen AP. Low birthweight at term and the timing of fetal exposure to maternal smoking. Am J Public Health. 1994;84(7):1127-31.
  • 15. Berghella V. Prevention of recurrent fetal growth restriction. Obstet Gynecol. 2007;110(4):904-12.
  • 16. Khoury MJ, Erickson JD, Cordero JF, McCarthy BJ. Congenital malformations and intrauterine growth retardation: a population study. Pediatrics. 1988;82(1):83-90.
  • 17. Meler E, Sisterna S, Borrell A. Genetic syndromes associated with isolated fetal growth restriction. Prenat Diagn. 2020;40(4):432-46.
  • 18. Maggio L, Dahlke JD, Mendez-Figueroa H, Albright CM, Chauhan SP, Wenstrom KD. Perinatal outcomes with normal compared with elevated umbilical artery systolic-to-diastolic ratios in fetal growth restriction. Obstet Gynecol. 2015;125(4):863-9.
  • 19. Vasconcelos RP, Brazil Frota Aragão JR, Costa Carvalho FH, Salani Mota RM, de Lucena Feitosa FE, Alencar Júnior CA. Differences in neonatal outcome in fetuses with absent versus reverse end-diastolic flow in umbilical artery Doppler. Fetal Diagn Ther. 2010;28(3):160-6.
  • 20. Baschat AA, Gembruch U, Weiner CP, Harman CR. Qualitative venous Doppler waveform analysis improves prediction of critical perinatal outcomes in premature growth-restricted fetuses. Ultrasound Obstet Gynecol. 2003;22(3):240-5.
  • 21. Boers KE, van Wyk L, van der Post JA, Kwee A, van Pampus MG, Spaanderdam ME, et al. 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(4):344.e1-7.

Erken ve geç başlangıçlı intrauterin gelişme geriliğinin perinatal sonuçları

Year 2020, Volume: 45 Issue: 4, 1758 - 1767, 27.12.2020
https://doi.org/10.17826/cumj.839861

Abstract

Amaç: Bu çalışmanın amacı erken ve geç başlangıçlı İntrauterin gelişme geriliği (İUGG) perinatal sonuçlara etkisini ve aradaki farkları gösterilmesidir.
Gereç ve Yöntem: Çalışmamız retrospektif bir çalışmadır. Çalışmamızda 01 Ocak 2015- 01 Ocak 2019 tarihleri arasında İUGG tanısıyla takibe 334 hasta erken ve geç başlangıçlı IUGG olmak üzere alt gruplara ayrıldı. Gelişme geriliği tipi, tanı aldığı gebelik haftası, tahmini fetal ağırlığı (TFA), preeklampsi varlığı, Doppler bulguları, doğum kilosu, doğum şekli, doğum haftası, 5.dk Apgar skoru, yenidoğan yoğun bakım ihtiyacı kayıt edildi ve tüm bu parametrelerin yenidoğanın olumsuz sonuçlarıyla ilişkisi ele alındı.
Bulgular: Tanı konulan gebelik haftası ortalaması 30,9±4,5 (min-maks:18-39)’dır. Hastaların doğum haftası ortalaması 34,4±4,5 (min-maks:22-41)’dır. Hastalar tanı aldıkları gebelik haftasına göre <27+6, 28-31, 32-36, >37 hafta olarak dört grupta incelendi. Verilerimiz doppler bulgularının şiddeti ile perinatal sonuçların kötüleştiğini ortaya koymaktadır. Yine çalışmamız TFA<%3 persentil olmasının ve erken başlangıçlı IUGG olmasının fetüslerin perinatal sonuçlarını olumsuz etkilediğini gösterdi.
Sonuç: Geç başlangıçlı preeklampsi IUGG’li bebeklerin perinatal sonuçlarını olumsuz etkilememektedir fakat erken başlangıçlı preeklampsi yenidoğan morbidite ve mortalitesindeki artışa neden olmaktadır. Bu sebeple erken başlangıçlı preeklampsinin eşlik ettiği erken başlangıçlı IUGG’li hastalar daha yakından takip edilmeli ve perinatal morbidite ve mortalite için uyanık olunmalıdır.

References

  • 1. Unterscheider J, Daly S, Geary MP, Kennelly MM, McAuliffe FM, O'Donoghue K, et al. Optimizing the definition of intrauterine growth restriction: the multicenter prospective PORTO Study. Am J Obstet Gynecol. 2013;208(4):290.e1-6.
  • 2. Olsen IE, Groveman SA, Lawson ML, Clark RH, Zemel BS. New intrauterine growth curves based on United States data. Pediatrics. 2010;125(2):e214-24.
  • 3. Odibo AO, Francis A, Cahill AG, Macones GA, Crane JP, Gardosi J. Association between pregnancy complications and small-for-gestational-age birth weight defined by customized fetal growth standard versus a population-based standard. J Matern Fetal Neonatal Med. 2011;24(3):411-7.
  • 4. Buck Louis GM, Grewal J, Albert PS, Sciscione A, Wing DA, Grobman WA, et al. Racial/ethnic standards for fetal growth: the NICHD Fetal Growth Studies. Am J Obstet Gynecol. 2015;213(4):449.e1-.e41.
  • 5. Barker ED, McAuliffe FM, Alderdice F, Unterscheider J, Daly S, Geary MP, et al. The role of growth trajectories in classifying fetal growth restriction. Obstet Gynecol. 2013;122(2 Pt 1):248-54.
  • 6. Chappell LC, Enye S, Seed P, Briley AL, Poston L, Shennan AH. Adverse perinatal outcomes and risk factors for preeclampsia in women with chronic hypertension: a prospective study. Hypertension. 2008;51(4):1002-9.
  • 7. Aagaard-Tillery KM, Porter TF, Lane RH, Varner MW, Lacoursiere DY. In utero tobacco exposure is associated with modified effects of maternal factors on fetal growth. Am J Obstet Gynecol. 2008;198(1):66.e1-6.
  • 8. Strandberg-Larsen K, Tinggaard M, Nybo Andersen AM, Olsen J, Grønbaek M. Use of nicotine replacement therapy during pregnancy and stillbirth: a cohort study. Bjog. 2008;115(11):1405-10.
  • 9. Selling KE, Carstensen J, Finnström O, Sydsjö G. Intergenerational effects of preterm birth and reduced intrauterine growth: a population-based study of Swedish mother-offspring pairs. Bjog. 2006;113(4):430-40.
  • 10. Arduini D, Rizzo G, Caforio L, Boccolini MR, Romanini C, Mancuso S. Behavioural state transitions in healthy and growth retarded fetuses. Early Hum Dev. 1989;19(3):155-65.
  • 11. Simon NV, O'Connor TJ, 3rd, Shearer DM. Detection of intrauterine fetal growth retardation with abdominal circumference and estimated fetal weight using cross-sectional growth curves. J Clin Ultrasound. 1990;18(9):685-90.
  • 12. Melekoglu R, Yilmaz E, Yasar S, Hatipoglu I, Kahveci B, Sucu M. The ability of various cerebroplacental ratio thresholds to predict adverse neonatal outcomes in term fetuses exhibiting late-onset fetal growth restriction. J Perinat Med. 2020; doi: 10.1515/jpm-2020-0244 (in press).
  • 13. Gaudineau A. [Prevalence, risk factors, maternal and fetal morbidity and mortality of intrauterine growth restriction and small-for-gestational age]. J Gynecol Obstet Biol Reprod (Paris). 2013;42(8):895-910.
  • 14. Lieberman E, Gremy I, Lang JM, Cohen AP. Low birthweight at term and the timing of fetal exposure to maternal smoking. Am J Public Health. 1994;84(7):1127-31.
  • 15. Berghella V. Prevention of recurrent fetal growth restriction. Obstet Gynecol. 2007;110(4):904-12.
  • 16. Khoury MJ, Erickson JD, Cordero JF, McCarthy BJ. Congenital malformations and intrauterine growth retardation: a population study. Pediatrics. 1988;82(1):83-90.
  • 17. Meler E, Sisterna S, Borrell A. Genetic syndromes associated with isolated fetal growth restriction. Prenat Diagn. 2020;40(4):432-46.
  • 18. Maggio L, Dahlke JD, Mendez-Figueroa H, Albright CM, Chauhan SP, Wenstrom KD. Perinatal outcomes with normal compared with elevated umbilical artery systolic-to-diastolic ratios in fetal growth restriction. Obstet Gynecol. 2015;125(4):863-9.
  • 19. Vasconcelos RP, Brazil Frota Aragão JR, Costa Carvalho FH, Salani Mota RM, de Lucena Feitosa FE, Alencar Júnior CA. Differences in neonatal outcome in fetuses with absent versus reverse end-diastolic flow in umbilical artery Doppler. Fetal Diagn Ther. 2010;28(3):160-6.
  • 20. Baschat AA, Gembruch U, Weiner CP, Harman CR. Qualitative venous Doppler waveform analysis improves prediction of critical perinatal outcomes in premature growth-restricted fetuses. Ultrasound Obstet Gynecol. 2003;22(3):240-5.
  • 21. Boers KE, van Wyk L, van der Post JA, Kwee A, van Pampus MG, Spaanderdam ME, et al. 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(4):344.e1-7.
There are 21 citations in total.

Details

Primary Language Turkish
Subjects Obstetrics and Gynaecology
Journal Section Research
Authors

Gülmira Aliyeva This is me 0000-0002-5572-495X

Mete Sucu 0000-0002-6889-7147

Publication Date December 27, 2020
Acceptance Date December 20, 2020
Published in Issue Year 2020 Volume: 45 Issue: 4

Cite

MLA Aliyeva, Gülmira and Mete Sucu. “Erken Ve Geç başlangıçlı Intrauterin gelişme geriliğinin Perinatal sonuçları”. Cukurova Medical Journal, vol. 45, no. 4, 2020, pp. 1758-67, doi:10.17826/cumj.839861.