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Fetal cerebral Doppler changes and outcome in late preterm fetal growth restriction: prospective cohort study
T. Stampalija, J. Thornton, N. Marlow, R. Napolitano, A. Bhide, T. Pickles, CM. Bilardo, SJ. Gordijn, W. Gyselaers, H. Valensise, K. Hecher, RK. Sande, P. Lindgren, E. Bergman, B. Arabin, AC. Breeze, L. Wee, W. Ganzevoort, J. Richter, A. Berger,...
Language English Country Great Britain
Document type Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't
Grant support
NIHR127976
Department of Health - United Kingdom
Else Kröner-Fresenius-Stiftung
Imperial College London
PubMed
32557921
DOI
10.1002/uog.22125
Knihovny.cz E-resources
- MeSH
- Middle Cerebral Artery diagnostic imaging embryology MeSH
- Umbilical Arteries diagnostic imaging embryology MeSH
- Adult MeSH
- Gestational Age MeSH
- Fetal Weight MeSH
- Infant, Small for Gestational Age MeSH
- Humans MeSH
- Stillbirth MeSH
- Live Birth MeSH
- Infant, Newborn MeSH
- Waist Circumference MeSH
- Fetus blood supply diagnostic imaging physiopathology MeSH
- Birth Weight MeSH
- Prospective Studies MeSH
- Pulsatile Flow MeSH
- Reference Values MeSH
- Rheology * MeSH
- Fetal Growth Retardation diagnostic imaging physiopathology MeSH
- Pregnancy MeSH
- Ultrasonography, Doppler * MeSH
- Ultrasonography, Prenatal * MeSH
- Fetal Development * MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Infant, Newborn MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Europe MeSH
OBJECTIVES: To explore the association between fetal umbilical and middle cerebral artery (MCA) Doppler abnormalities and outcome in late preterm pregnancies at risk of fetal growth restriction. METHODS: This was a prospective cohort study of singleton pregnancies at risk of fetal growth restriction at 32 + 0 to 36 + 6 weeks of gestation, enrolled in 33 European centers between 2017 and 2018, in which umbilical and fetal MCA Doppler velocimetry was performed. Pregnancies were considered at risk of fetal growth restriction if they had estimated fetal weight and/or abdominal circumference (AC) < 10th percentile, abnormal arterial Doppler and/or a fall in AC growth velocity of more than 40 percentile points from the 20-week scan. Composite adverse outcome comprised both immediate adverse birth outcome and major neonatal morbidity. Using a range of cut-off values, the association of MCA pulsatility index and umbilicocerebral ratio (UCR) with composite adverse outcome was explored. RESULTS: The study population comprised 856 women. There were two (0.2%) intrauterine deaths. Median gestational age at delivery was 38 (interquartile range (IQR), 37-39) weeks and birth weight was 2478 (IQR, 2140-2790) g. Compared with infants with normal outcome, those with composite adverse outcome (n = 93; 11%) were delivered at an earlier gestational age (36 vs 38 weeks) and had a lower birth weight (1900 vs 2540 g). The first Doppler observation of MCA pulsatility index < 5th percentile and UCR Z-score above gestational-age-specific thresholds (1.5 at 32-33 weeks and 1.0 at 34-36 weeks) had the highest relative risks (RR) for composite adverse outcome (RR 2.2 (95% CI, 1.5-3.2) and RR 2.0 (95% CI, 1.4-3.0), respectively). After adjustment for confounders, the association between UCR Z-score and composite adverse outcome remained significant, although gestational age at delivery and birth-weight Z-score had a stronger association. CONCLUSION: In this prospective multicenter study, signs of cerebral blood flow redistribution were found to be associated with adverse outcome in late preterm singleton pregnancies at risk of fetal growth restriction. Whether cerebral redistribution is a marker describing the severity of fetal growth restriction or an independent risk factor for adverse outcome remains unclear, and whether it is useful for clinical management can be answered only in a randomized trial. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
Center for Fetal Medicine Karolinska University Hospital Stockholm Sweden
Centre for Trials Research College of Biomedical and Life Sciences Cardiff University Cardiff UK
Department of Medicine Surgery and Health Sciences University of Trieste Trieste Italy
Department of Obstetrics and Gynecology Haukeland University Hospital Bergen Norway
Department of Obstetrics and Gynecology Medical University of Graz Graz Austria
Department of Obstetrics and Gynecology Medical University of Innsbruck Innsbruck Austria
Department of Obstetrics and Gynecology University Hospital of Bern Bern Switzerland
Department of Obstetrics and Gynecology University of Parma Parma Italy
Department of Perinatal Medicine University of Utrecht Utrecht The Netherlands
Department of Women's and Children's Health Uppsala University Uppsala Sweden
Faculty of Medicine and Life Sciences Hasselt University Agoralaan Diepenbeek Belgium
Fetal Medicine Unit Leeds General Infirmary Leeds Teaching Hospitals NHS Trust Leeds UK
Fetal Medicine Unit University College London Hospitals NHS Foundation Trust London UK
St Olav's Hospital Trondheim Norway
The Princess Alexandra Hospital NHS Trust Harlow UK
UCL Elizabeth Garrett Anderson Institute for Women's Health University College London London UK
References provided by Crossref.org
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- $a Fetal cerebral Doppler changes and outcome in late preterm fetal growth restriction: prospective cohort study / $c T. Stampalija, J. Thornton, N. Marlow, R. Napolitano, A. Bhide, T. Pickles, CM. Bilardo, SJ. Gordijn, W. Gyselaers, H. Valensise, K. Hecher, RK. Sande, P. Lindgren, E. Bergman, B. Arabin, AC. Breeze, L. Wee, W. Ganzevoort, J. Richter, A. Berger, J. Brodszki, J. Derks, F. Mecacci, GM. Maruotti, K. Myklestad, SM. Lobmaier, F. Prefumo, P. Klaritsch, P. Calda, C. Ebbing, T. Frusca, L. Raio, GHA. Visser, L. Krofta, I. Cetin, E. Ferrazzi, E. Cesari, H. Wolf, CC. Lees, TRUFFLE-2 Group
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- $a OBJECTIVES: To explore the association between fetal umbilical and middle cerebral artery (MCA) Doppler abnormalities and outcome in late preterm pregnancies at risk of fetal growth restriction. METHODS: This was a prospective cohort study of singleton pregnancies at risk of fetal growth restriction at 32 + 0 to 36 + 6 weeks of gestation, enrolled in 33 European centers between 2017 and 2018, in which umbilical and fetal MCA Doppler velocimetry was performed. Pregnancies were considered at risk of fetal growth restriction if they had estimated fetal weight and/or abdominal circumference (AC) < 10th percentile, abnormal arterial Doppler and/or a fall in AC growth velocity of more than 40 percentile points from the 20-week scan. Composite adverse outcome comprised both immediate adverse birth outcome and major neonatal morbidity. Using a range of cut-off values, the association of MCA pulsatility index and umbilicocerebral ratio (UCR) with composite adverse outcome was explored. RESULTS: The study population comprised 856 women. There were two (0.2%) intrauterine deaths. Median gestational age at delivery was 38 (interquartile range (IQR), 37-39) weeks and birth weight was 2478 (IQR, 2140-2790) g. Compared with infants with normal outcome, those with composite adverse outcome (n = 93; 11%) were delivered at an earlier gestational age (36 vs 38 weeks) and had a lower birth weight (1900 vs 2540 g). The first Doppler observation of MCA pulsatility index < 5th percentile and UCR Z-score above gestational-age-specific thresholds (1.5 at 32-33 weeks and 1.0 at 34-36 weeks) had the highest relative risks (RR) for composite adverse outcome (RR 2.2 (95% CI, 1.5-3.2) and RR 2.0 (95% CI, 1.4-3.0), respectively). After adjustment for confounders, the association between UCR Z-score and composite adverse outcome remained significant, although gestational age at delivery and birth-weight Z-score had a stronger association. CONCLUSION: In this prospective multicenter study, signs of cerebral blood flow redistribution were found to be associated with adverse outcome in late preterm singleton pregnancies at risk of fetal growth restriction. Whether cerebral redistribution is a marker describing the severity of fetal growth restriction or an independent risk factor for adverse outcome remains unclear, and whether it is useful for clinical management can be answered only in a randomized trial. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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