Journal
ULTRASOUND IN OBSTETRICS & GYNECOLOGY
Volume 39, Issue 3, Pages 299-303Publisher
WILEY
DOI: 10.1002/uog.10150
Keywords
decision tree; Doppler; growth restriction; IUGR; perinatal outcome; SGA; weight centile
Funding
- Fondo de Investigacion Sanitaria (Spain) [PI/060347]
- Cerebra Foundation for the Brain Injured Child (Carmarthen, Wales, UK)
- Thrasher Research Fund (Salt Lake City, USA)
- Fundacion Eugenio Rodriguez Pascual (Spain)
- Marie Curie Host Fellowship [FETAL-MED-019707]
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Objective To evaluate the risk of adverse perinatal outcome according to estimated fetal weight (EFW) in a cohort of term small-for-gestational-age (SGA) pregnancies with normal umbilical, fetal middle cerebral and maternal uterine artery Doppler indices. Methods A cohort of 132 term SGA fetuses with normal umbilical artery pulsatility index (PI), mean uterine artery PI and cerebroplacental ratio was compared to a control group of 132 appropriate-for-gestational-age babies, matched by gestational age at delivery. The capacity of the EFW percentile to predict Cesarean delivery, Cesarean delivery for non-reassuring fetal status (NRFS), neonatal acidosis and days of neonatal hospitalization was analyzed. Results As a whole, SGA fetuses with normal Doppler findings did not show a statistically significant difference for intrapartum Cesarean delivery (22.0 vs. 15.9%; P = 0.21) and neonatal acidosis (3.3 vs. 1.5%; P = 0.30), but had significantly higher risk for Cesarean delivery for NRFS (15.9 vs. 5.3%; P < 0.01) and longer neonatal hospitalization (1.39 vs. 0.87 days; P < 0.05) than did controls. SGA fetuses with EFW < 3rd centile had a significantly higher incidence of intrapartum Cesarean delivery (30.0 vs. 15.3%; P = 0.04), Cesarean delivery for NRFS (25.0 vs. 8.3%; P < 0.01) and longer neonatal hospitalization (2.0 vs. 0.9 days; P < 0.01) than those with EFW = 3rd centile. SGA cases with EFW = 3rd centile had perinatal outcomes similar to those of controls with normal EFW. Conclusion Among SGA fetuses with normal placental and cerebral Doppler ultrasound findings, EFW < 3rd centile discriminates between those with a higher risk for adverse perinatal outcome and those with outcomes similar to those of normally grown fetuses. Copyright (C) 2012 ISUOG. Published by John Wiley & Sons, Ltd.
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