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ERKEN VE GEÇ BAŞLANGIÇLI FETAL GELİŞİM KISITLILIĞINDA PERİNATAL SONUÇLAR VE PROGNOSTİK FAKTÖRLER

Yıl 2022, Cilt: 85 Sayı: 2, 170 - 176, 24.03.2022
https://doi.org/10.26650/IUITFD.10008808

Öz

Amaç: Erken (EB) ve geç (GB) başlangıçlı fetal gelişim kısıtlılığı (FGK) olgularında obstetrik ve perinatal sonuçların değerlendirilmesi ve perinatal sağ kalım ile olumsuz perinatal sonuçlar üzerine etkili prognostik faktörlerin saptanması. Gereç ve Yöntem: Tekil 105 EB- ve 55 GB-FGK olan gebelik retrospektif olarak derlendi. Umblikal arter (UA), orta serebral arter (MCA) ve duktus venozus (DV) Doppler parametreleri ile serebroplasental oran (CPR) değerlendirildi. Doğumdaki gebelik haftası, doğum ağırlığı ve Doppler parametrelerinin prognostik anlamı incelendi. Bulgular: Doğumun 27. gebelik haftasından sonra gerçekleşmesi (duyarlılık %87,5, özgüllük %76) ve doğum ağırlığının 665 gr’ın üzerinde olması (duyarlılık %88,8, özgüllük %92) EB-FGK olgularında en iyi sağ kalım öngörüsünü sağladı. Lojistik regresyon analizinde, UA diyastol sonu akımın (EDF) kaybı ve ters akım olması, anormal DV Doppler ve DV a dalgasının kaybı/ters a dalgası EB-FGK’da perinatal mortalite ile ilişkili bulundu (sırasıyla olasılık oranları %2,57, 6,97, 4,51 ve 8,75). Olumsuz sonuçların eşlik ettiği GB-FGK’da, normal sonuçların izlendiği olgulara kıyasla, CPR’ın 5. persentilin altında olma oranı istatiksel olarak anlamlı bulundu (p<0,001). Sonuç: EB-FGK’da doğumdaki gebelik haftası ve doğum ağırlığı en kuvvetli prediktörlerdir. GB-FGK’da, CPR’ın <5. persentil olması doğum komplikasyonları açısından artmış risk ile ilişkilidir.

Kaynakça

  • 1. Gordijn S, Beune I, Thilaganathan B, Papageorghiou A, Baschat A, Baker P, et al. Consensus definition of fetal growth restriction: a Delphi procedure. Ultrasound Obstet Gynecol 2016;48(3):333-9. [CrossRef]
  • 2. Nawathe A, Lees C. Early onset fetal growth restriction. Best Pract Res Clin Obstet Gynaecol 2017;38:24-37. [CrossRef]
  • 3. Spinillo A, Gardella B, Adamo L, Muscettola G, Fiandrino G, Cesari S. Pathologic placental lesions in early and late fetal growth restriction. Acta Obstet Gynecol Scand 2019;98(12):1585-94. [CrossRef]
  • 4. Figueras F, Gratacos 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. [CrossRef]
  • 5. Figueras F, Caradeux J, Crispi F, Eixarch E, Peguero A, Gratacos E. Diagnosis and surveillance of late-onset fetal growth restriction. Am J Obstet Gynecol 2018;218(2S):790- 802. [CrossRef]
  • 6. Bilardo CM, Hecher K, Visser GHA, Papageorghiou A, Marlow N, Thilaganathan B, et al. Severe fetal growth restriction at 26-32 weeks: key messages from the TRUFFLE study. Ultrasound Obstet Gynecol 2017;50(3):285-90. [CrossRef]
  • 7. DeVore GR. The importance of the cerebroplacental ratio in the evaluation of fetal well-being in SGA and AGA fetuses. Am J Obstet Gynecol 2015;213(1):5-15. [CrossRef]
  • 8. Hadlock F, Harrist RB, Carpenter RJ, Deter RL, Park SK. Sonographic estimation of fetal weight. The value of femur length in addition to head and abdomen measurements. Radiology 1984;150(2):535-40. [CrossRef]
  • 9. Bhide A, Acharya G, Bilardo CM, Brezinka C, Cafici D, Hernandez-Andrade E, et al. ISUOG practice guidelines: use of Doppler ultrasonography in obstetrics. Ultrasound Obstet Gynecol 2013;41(2):233-39. [CrossRef]
  • 10. Gómez O, Figueras F, Fernández S, Bennasar M, Martínez J, Puerto B, et al. Reference ranges for uterine artery mean pulsatility index at 11-41 weeks of gestation. Ultrasound Obstet Gynecol 2008;32(2):128-32. [CrossRef]
  • 11. ACOG Practice bulletin no. 204: Fetal Growth Restriction. Obstet Gynecol 2019;133:e97-e109. [CrossRef]
  • 12. Royal College of Obstetricians and Gynaecologists. Smallfor- Gestational-Age Fetus, Investigation and Management (Green-top Guideline No. 31). 2nd edition, 2013. https:// www.rcog.org.uk/en/guidelines-research-services/ guidelines/gtg31/
  • 13. Baschat A, Gembruch U. The cerebroplacental Doppler ratio revisited. Ultrasound Obstet Gynecol 2003;21(2):124- 7. [CrossRef]
  • 14. Ayres-de-Campos D, Spong CY, Chandraharan E. FIGO consensus guidelines on intrapartum fetal monitoring: Cardiotocography. Int J Gynaecol Obstet 2015;131(1):1324. [CrossRef]
  • 15. Savchev S, Figueras F, Sanz-Cortes M, Cruz-Lemini M, Triunfo S, Botet F, et al. Evaluation of an optimal gestational age cut-off for the definition of early-and late-onset fetal growth restriction. Fetal DiagnTher 2014;36(2):99-105. [CrossRef]
  • 16. Inácio QAS, Arauojo Júnior E, Nardozza LMM, Petrini CG, Campos VP, Peixoto AB. Perinatal outcomes of fetuses with early growth restriction, late growth restriction, small for gestational age, and adequate for gestational age. Rev Bras Ginecol Obstet 2019;41(12):688. [CrossRef]
  • 17. Madazli R, Somunkiran A, Calay Z, Ilvan S, Aksu M. Histomorphology of the placenta and the placental bed of growth restricted foetuses and correlation with the Doppler velocimetries of the uterine and umbilical arteries. Placenta 2003;24(5):510-6. [CrossRef]
  • 18. Lees C, Marlow N, Arabin B, Bilardo CM, Brezinka C, Derks J et al. Perinatal morbidity and mortality in early onset fetal growth restriction: cohort outcomes of the trial of randomized umbilical and fetal flow in Europe (TRUFFLE). Ultrasound Obstet Gynecol 2013;42(4):400-8. [CrossRef]
  • 19. Monier I, Ancel PY, Ego A, Guellec I, Jarreau PH, Kaminski M, et al. Gestational age at diagnosis of early onset fetal growth restriction and impact on management and survival: a population based cohort study. BJOG 2017;124(12):1899- 906. [CrossRef]
  • 20. Baschat AA, Cosmi E, Bilardo CM, Wolf H, Berg C, Rigano S, et al. Predictors of neonatal outcome in early-onset placental dysfunction. Obstet Gynecol 2007;109:253-61. [CrossRef]
  • 21. Baião AER, de Carvalho PRN, Lopes MM, de Sã RAM, Junior SCG. Predictors of perinatal outcome in early-onset fetal growth restriction: a study from an emerging economy country. Prenatal diagnosis 2019;40(3):373-39. [CrossRef]
  • 22. Stampalija T, Arabin B, Wolf H, Bilardo CM, Lees C. Is middle cerebral artery Doppler related to neonatal and 2-year infant outcome in early fetal growth restriction? Am J Obstet Gynecol 2017;216(5):521.e1-521.e13. [CrossRef]
  • 23. Caradeux J, Martinez-Portilla RJ, Basuki TR, Kiserud T, Figueras F. Risk of fetal death in growth-restricted fetuses with umbilical and/or ductus venosus absent or reversed end diastolic velocities before 34 weeks of gestation: a systematic review and meta-analysis. Am J Obstet Gynecol 2018;218(2S):S774-82. [CrossRef]
  • 24. Arcangeli T, Thilaganathan B, Hooper R, Khan KS, Bhide A. Neurodevelopmental delay in small babies at term: a systematic review. Ultrasound Obstet Gynecol 2012;40(3):267-75. [CrossRef]
  • 25. Dunn L, Sherrell H, Kumar S. Systematic review of the utility of the fetal cerebroplacental ratio measured at term for the prediction of adverse perinatal outcome. Placenta 2017;54:68-75. [CrossRef]
  • 26. Vollgraff Heidweiller-Schreurs CA, De Boer MA, Heymans MW, Schoonmade L, Bossuyt P, Mol B, et al. Prognostic accuracy of cerebroplacental ratio and middle cerebral artery Doppler for adverse perinatal outcome: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2018;51(3):313. [CrossRef]

PERINATAL OUTCOMES AND PROGNOSTIC FACTORS IN EARLY AND LATE-ONSET FETAL GROWTH RESTRICTION

Yıl 2022, Cilt: 85 Sayı: 2, 170 - 176, 24.03.2022
https://doi.org/10.26650/IUITFD.10008808

Öz

Objective: To evaluate the obstetric and perinatal outcomes of fetuses with early (EO) and late-onset (LO) fetal growth restriction (FGR), and to explore the prognostic factors on perinatal survival and adverse perinatal outcome. Materials and Methods: We retrospectively reviewed 105 EO and 55 LO-FGR singleton pregnancies. Umbilical artery (UA), middle cerebral artery (MCA) and ductus venosus (DV) Doppler parameters and cerebroplacental ratio (CPR) were assessed. Prognostic significance of gestational age at delivery, birth weight and Doppler parameters were evaluated. Results: Gestational age at delivery greater than 27 weeks (sensitivity 87.5%, specificity 76%) and birth weight of 665 g (sensitivity 88.8%, specificity 92%) provided the best prediction of survival in EO-FGR. Logistic regression analysis of UA absent or reversed end diastolic flow (EDF), abnormal DV Doppler, and absent/reversed DV a-wave revealed Odds Ratios of 2.57, 6.97, 4.51 and 8.75 respectively for perinatal mortality in EO-FGR. The incidence of CPR below the 5th percentile was significantly higher in LO-FGR pregnancies with the composite adverse outcome than normal outcome (p<0.001). Conclusion: Gestational age at delivery and birth weight are the strongest predictors of perinatal mortality in EO-FGR. In LOFGR, CPR <5th percentile is associated with an increased risk of delivery complications.

Kaynakça

  • 1. Gordijn S, Beune I, Thilaganathan B, Papageorghiou A, Baschat A, Baker P, et al. Consensus definition of fetal growth restriction: a Delphi procedure. Ultrasound Obstet Gynecol 2016;48(3):333-9. [CrossRef]
  • 2. Nawathe A, Lees C. Early onset fetal growth restriction. Best Pract Res Clin Obstet Gynaecol 2017;38:24-37. [CrossRef]
  • 3. Spinillo A, Gardella B, Adamo L, Muscettola G, Fiandrino G, Cesari S. Pathologic placental lesions in early and late fetal growth restriction. Acta Obstet Gynecol Scand 2019;98(12):1585-94. [CrossRef]
  • 4. Figueras F, Gratacos 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. [CrossRef]
  • 5. Figueras F, Caradeux J, Crispi F, Eixarch E, Peguero A, Gratacos E. Diagnosis and surveillance of late-onset fetal growth restriction. Am J Obstet Gynecol 2018;218(2S):790- 802. [CrossRef]
  • 6. Bilardo CM, Hecher K, Visser GHA, Papageorghiou A, Marlow N, Thilaganathan B, et al. Severe fetal growth restriction at 26-32 weeks: key messages from the TRUFFLE study. Ultrasound Obstet Gynecol 2017;50(3):285-90. [CrossRef]
  • 7. DeVore GR. The importance of the cerebroplacental ratio in the evaluation of fetal well-being in SGA and AGA fetuses. Am J Obstet Gynecol 2015;213(1):5-15. [CrossRef]
  • 8. Hadlock F, Harrist RB, Carpenter RJ, Deter RL, Park SK. Sonographic estimation of fetal weight. The value of femur length in addition to head and abdomen measurements. Radiology 1984;150(2):535-40. [CrossRef]
  • 9. Bhide A, Acharya G, Bilardo CM, Brezinka C, Cafici D, Hernandez-Andrade E, et al. ISUOG practice guidelines: use of Doppler ultrasonography in obstetrics. Ultrasound Obstet Gynecol 2013;41(2):233-39. [CrossRef]
  • 10. Gómez O, Figueras F, Fernández S, Bennasar M, Martínez J, Puerto B, et al. Reference ranges for uterine artery mean pulsatility index at 11-41 weeks of gestation. Ultrasound Obstet Gynecol 2008;32(2):128-32. [CrossRef]
  • 11. ACOG Practice bulletin no. 204: Fetal Growth Restriction. Obstet Gynecol 2019;133:e97-e109. [CrossRef]
  • 12. Royal College of Obstetricians and Gynaecologists. Smallfor- Gestational-Age Fetus, Investigation and Management (Green-top Guideline No. 31). 2nd edition, 2013. https:// www.rcog.org.uk/en/guidelines-research-services/ guidelines/gtg31/
  • 13. Baschat A, Gembruch U. The cerebroplacental Doppler ratio revisited. Ultrasound Obstet Gynecol 2003;21(2):124- 7. [CrossRef]
  • 14. Ayres-de-Campos D, Spong CY, Chandraharan E. FIGO consensus guidelines on intrapartum fetal monitoring: Cardiotocography. Int J Gynaecol Obstet 2015;131(1):1324. [CrossRef]
  • 15. Savchev S, Figueras F, Sanz-Cortes M, Cruz-Lemini M, Triunfo S, Botet F, et al. Evaluation of an optimal gestational age cut-off for the definition of early-and late-onset fetal growth restriction. Fetal DiagnTher 2014;36(2):99-105. [CrossRef]
  • 16. Inácio QAS, Arauojo Júnior E, Nardozza LMM, Petrini CG, Campos VP, Peixoto AB. Perinatal outcomes of fetuses with early growth restriction, late growth restriction, small for gestational age, and adequate for gestational age. Rev Bras Ginecol Obstet 2019;41(12):688. [CrossRef]
  • 17. Madazli R, Somunkiran A, Calay Z, Ilvan S, Aksu M. Histomorphology of the placenta and the placental bed of growth restricted foetuses and correlation with the Doppler velocimetries of the uterine and umbilical arteries. Placenta 2003;24(5):510-6. [CrossRef]
  • 18. Lees C, Marlow N, Arabin B, Bilardo CM, Brezinka C, Derks J et al. Perinatal morbidity and mortality in early onset fetal growth restriction: cohort outcomes of the trial of randomized umbilical and fetal flow in Europe (TRUFFLE). Ultrasound Obstet Gynecol 2013;42(4):400-8. [CrossRef]
  • 19. Monier I, Ancel PY, Ego A, Guellec I, Jarreau PH, Kaminski M, et al. Gestational age at diagnosis of early onset fetal growth restriction and impact on management and survival: a population based cohort study. BJOG 2017;124(12):1899- 906. [CrossRef]
  • 20. Baschat AA, Cosmi E, Bilardo CM, Wolf H, Berg C, Rigano S, et al. Predictors of neonatal outcome in early-onset placental dysfunction. Obstet Gynecol 2007;109:253-61. [CrossRef]
  • 21. Baião AER, de Carvalho PRN, Lopes MM, de Sã RAM, Junior SCG. Predictors of perinatal outcome in early-onset fetal growth restriction: a study from an emerging economy country. Prenatal diagnosis 2019;40(3):373-39. [CrossRef]
  • 22. Stampalija T, Arabin B, Wolf H, Bilardo CM, Lees C. Is middle cerebral artery Doppler related to neonatal and 2-year infant outcome in early fetal growth restriction? Am J Obstet Gynecol 2017;216(5):521.e1-521.e13. [CrossRef]
  • 23. Caradeux J, Martinez-Portilla RJ, Basuki TR, Kiserud T, Figueras F. Risk of fetal death in growth-restricted fetuses with umbilical and/or ductus venosus absent or reversed end diastolic velocities before 34 weeks of gestation: a systematic review and meta-analysis. Am J Obstet Gynecol 2018;218(2S):S774-82. [CrossRef]
  • 24. Arcangeli T, Thilaganathan B, Hooper R, Khan KS, Bhide A. Neurodevelopmental delay in small babies at term: a systematic review. Ultrasound Obstet Gynecol 2012;40(3):267-75. [CrossRef]
  • 25. Dunn L, Sherrell H, Kumar S. Systematic review of the utility of the fetal cerebroplacental ratio measured at term for the prediction of adverse perinatal outcome. Placenta 2017;54:68-75. [CrossRef]
  • 26. Vollgraff Heidweiller-Schreurs CA, De Boer MA, Heymans MW, Schoonmade L, Bossuyt P, Mol B, et al. Prognostic accuracy of cerebroplacental ratio and middle cerebral artery Doppler for adverse perinatal outcome: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2018;51(3):313. [CrossRef]
Toplam 26 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm ARAŞTIRMA
Yazarlar

Rıza Madazlı 0000-0002-6400-1964

Verda Alpay Bu kişi benim 0000-0002-5937-0220

Didem Kaymak Bu kişi benim 0000-0002-2755-1932

İpek Betül Özçivit 0000-0002-5645-7064

Yayımlanma Tarihi 24 Mart 2022
Gönderilme Tarihi 12 Ekim 2021
Yayımlandığı Sayı Yıl 2022 Cilt: 85 Sayı: 2

Kaynak Göster

APA Madazlı, R., Alpay, V., Kaymak, D., Özçivit, İ. B. (2022). PERINATAL OUTCOMES AND PROGNOSTIC FACTORS IN EARLY AND LATE-ONSET FETAL GROWTH RESTRICTION. Journal of Istanbul Faculty of Medicine, 85(2), 170-176. https://doi.org/10.26650/IUITFD.10008808
AMA Madazlı R, Alpay V, Kaymak D, Özçivit İB. PERINATAL OUTCOMES AND PROGNOSTIC FACTORS IN EARLY AND LATE-ONSET FETAL GROWTH RESTRICTION. İst Tıp Fak Derg. Mart 2022;85(2):170-176. doi:10.26650/IUITFD.10008808
Chicago Madazlı, Rıza, Verda Alpay, Didem Kaymak, ve İpek Betül Özçivit. “PERINATAL OUTCOMES AND PROGNOSTIC FACTORS IN EARLY AND LATE-ONSET FETAL GROWTH RESTRICTION”. Journal of Istanbul Faculty of Medicine 85, sy. 2 (Mart 2022): 170-76. https://doi.org/10.26650/IUITFD.10008808.
EndNote Madazlı R, Alpay V, Kaymak D, Özçivit İB (01 Mart 2022) PERINATAL OUTCOMES AND PROGNOSTIC FACTORS IN EARLY AND LATE-ONSET FETAL GROWTH RESTRICTION. Journal of Istanbul Faculty of Medicine 85 2 170–176.
IEEE R. Madazlı, V. Alpay, D. Kaymak, ve İ. B. Özçivit, “PERINATAL OUTCOMES AND PROGNOSTIC FACTORS IN EARLY AND LATE-ONSET FETAL GROWTH RESTRICTION”, İst Tıp Fak Derg, c. 85, sy. 2, ss. 170–176, 2022, doi: 10.26650/IUITFD.10008808.
ISNAD Madazlı, Rıza vd. “PERINATAL OUTCOMES AND PROGNOSTIC FACTORS IN EARLY AND LATE-ONSET FETAL GROWTH RESTRICTION”. Journal of Istanbul Faculty of Medicine 85/2 (Mart 2022), 170-176. https://doi.org/10.26650/IUITFD.10008808.
JAMA Madazlı R, Alpay V, Kaymak D, Özçivit İB. PERINATAL OUTCOMES AND PROGNOSTIC FACTORS IN EARLY AND LATE-ONSET FETAL GROWTH RESTRICTION. İst Tıp Fak Derg. 2022;85:170–176.
MLA Madazlı, Rıza vd. “PERINATAL OUTCOMES AND PROGNOSTIC FACTORS IN EARLY AND LATE-ONSET FETAL GROWTH RESTRICTION”. Journal of Istanbul Faculty of Medicine, c. 85, sy. 2, 2022, ss. 170-6, doi:10.26650/IUITFD.10008808.
Vancouver Madazlı R, Alpay V, Kaymak D, Özçivit İB. PERINATAL OUTCOMES AND PROGNOSTIC FACTORS IN EARLY AND LATE-ONSET FETAL GROWTH RESTRICTION. İst Tıp Fak Derg. 2022;85(2):170-6.

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