Respiratory outcome in preterm small for gestational age fetuses with or without abnormal umbilical artery Doppler and/or maternal hypertension

Objective. To study respiratory outcome in preterm small for gestational age ( SGA) fetuses with or without signs of intrauterine growth restriction due to placental insufficiency, and with or without maternal hypertension. Methods. This was a retrospective study of 187 neonates with birth weight < 10(th) percentile and gestational age < 34 weeks. Results from umbilical artery Doppler velocimetry were used to identify the abnormal Doppler subgroup. Results. No significant difference in respiratory outcome between SGA fetuses with normal ( SGA- N) or abnormal ( SGA- A) umbilical artery Doppler examination was found. Within the SGA- A group, the respiratory distress syndrome ( RDS) incidence ( OR 5.6, 95% CI 1.7 - 18.3), RDS grade ( OR 6.7, 95% CI 1.2 - 38.5), and need for surfactant ( OR 5.3, 95% CI 1.1 - 24.4) were higher in infants of women with hemolysis, elevated liver enzymes, low platelets ( HELLP) syndrome as compared to those of normotensive mothers. Conclusions. Lung maturation is not accelerated with placental insufficiency. SGA- A fetuses of mothers with HELLP syndrome have a significantly poorer respiratory outcome than those with healthy mothers. Possibly, fetuses of mothers with HELLP syndrome are subjected to 'oxidative stress' causing lung damage rather than lung maturation.