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Published on: June 29, 2013
Management of Very Early-onset Fetal Growth Restriction: Results from 92 Consecutive Cases
Friederike Hoellen1, Annika Beckmann2, Constanze Banz-Jansen2
1Department of Obstetrics and Gynaecology, University Hospital Schleswig-Holstein, Lübeck, Germany friederike.hoellen@uksh.de.
Insights
Early-onset intrauterine growth restriction (IUGR) management impacts infant outcomes. A "wait and see" approach may improve survival, but more research is needed for tailored care.
Area of Science:
- Perinatal Medicine
- Neonatology
- Obstetrics
Background:
- Intrauterine growth restriction (IUGR) presents significant challenges in early-onset cases.
- Management strategies for early-onset IUGR and preterm delivery require careful consideration.
Purpose of the Study:
- To evaluate the management of early-onset intrauterine growth restriction (IUGR).
- To define fetal and neonatal outcomes based on obstetric management settings.
Main Methods:
- Retrospective review of 92 pregnancies with IUGR and preterm delivery (<30 weeks gestation) between 2000-2011.
- Analysis of factors influencing fetal outcome, including gestational age at delivery and antenatal corticosteroid use.
Main Results:
- Sixteen of 92 infants (17.4%) died within one year postpartum.
- Severe early-onset IUGR contributed to iatrogenic preterm delivery and mortality in eight cases.
- Gestational age at delivery and antenatal corticosteroid exposure were critical determinants of fetal outcome.
Conclusions:
- A "wait and see" management approach, alongside respiratory distress syndrome prophylaxis, may be beneficial for prolonging pregnancy in select early-onset IUGR cases.
- Randomized prospective trials are essential to establish evidence-based guidelines for individualized management of early-onset preterm infants with IUGR.
Aim:
To evaluate management of early-onset intrauterine growth restriction (IUGR) and to define outcome according to obstetric setting.
Patients And Methods:
During an 11-year period (2000-2011), data of patients presenting with IUGR and preterm delivery of less than 30 weeks of gestation at a tertiary perinatal center were retrospectively reviewed.
Results:
A total of 92 pregnancies were investigated. Delivery was indicated for fetal reasons in 38 out of 92 patients. Sixteen children of our cohort died within one year post partum, out of which eight had suffered from severe early-onset IUGR causing iatrogenic preterm delivery. Concerning the fetal outcome, gestational age at delivery and antenatal exposure to corticosteroids were found to be crucial.
Conclusion:
In some cases, respiratory distress syndrome prophylaxis and a "wait and see" approach to management in favor of a prolongation of the pregnancy might be favorable. Randomized prospective trials in early-onset IUGR with threatened preterm deliveries are needed in order to define guidelines for an individually tailored management of early-onset preterm infants.
