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Published on: June 29, 2013
Early-onset fetal growth restriction: comparison of two management protocols in a single tertiary center
Ana Dagge1, Joana Barros1, André Graça2
1Department of Obstetrics, Gynecology and Reproductive Medicine - Northern Lisbon University Hospital, Lisbon, Portugal.
Insights
A new protocol for diagnosing fetal growth restriction (FGR) reduced diagnosed cases and delivery gestational age. Neonatal outcomes, including NICU admissions, showed significant differences, but serious adverse events did not increase.
Area of Science:
- Perinatal Medicine
- Maternal-Fetal Medicine
- Neonatology
Background:
- Early-onset fetal growth restriction (FGR) poses significant risks to neonates.
- Standardized diagnostic and surveillance protocols are crucial for managing FGR pregnancies.
- Previous management strategies varied, potentially impacting neonatal outcomes.
Purpose of the Study:
- To compare neonatal outcomes between two management protocols for early-onset FGR.
- To evaluate the impact of implementing updated guidelines on FGR diagnosis and management.
- To assess changes in obstetric and perinatal parameters following protocol revision.
Main Methods:
- Retrospective cohort study of 72 pregnancies with early-onset FGR (2017-2020).
- Comparison of outcomes between two management protocols implemented before and after 2019.
- Analysis of obstetric data, gestational age at delivery, and neonatal admission rates.
Main Results:
- Protocol 2 (post-2019) resulted in a significantly earlier mean gestational age at delivery (32.3 weeks) compared to Protocol 1 (34.9 weeks).
- Neonatal intensive care unit (NICU) admission rates were higher in Protocol 2 (74.1%) versus Protocol 1 (46.7%).
- No statistically significant differences were observed in other serious neonatal adverse outcomes between the two protocols.
Conclusions:
- The revised protocol, aligned with 2016 ISUOG guidelines, potentially decreased the incidence of diagnosed FGR.
- While leading to earlier deliveries, the new protocol did not elevate the risk of severe neonatal complications.
- This suggests a shift towards earlier intervention for FGR without compromising neonatal safety for severe outcomes.
Objective:
Compare the neonatal outcomes of two protocols of diagnosis and surveillance of pregnancies complicated by early-onset FGR in a tertiary hospital.
Methods:
This is a retrospective cohort study of pregnant women diagnosed with early-onset FGR between 2017 and 2020. We compared the obstetric and perinatal outcomes between two different management protocols (before and after 2019).
Results:
Seventy-two cases of early-onset FGR were diagnosed in the forementioned period: 45 (62.5%) were managed according to protocol 1 and 27 (37.5%) according to protocol 2. Mean gestational age at delivery was significantly different between groups: 34.9 ± 3.1 weeks (95% CI 34.0-35.9) in group 1 and 32.3 ± 4.4 weeks (95% CI 30.4-33.9) in group 2. 74.1% (20) of newborns in group 2 were admitted in de NICU, a significant difference when compared with 46.7% of group 1. There were no statistically significant differences in the remaining serious neonatal adverse outcomes.
Conclusions:
This is the first study published comparing two different protocols of management of FGR. The implementation of the new protocol seems to have led to a decrease in the number of fetuses labeled as growth restricted and to a decrease in the gestational age of delivery of such fetuses, but without increasing the rate of serious neonatal adverse outcomes.
Synopsis:
The implementation of the 2016 ISUOG guidelines for the diagnosis of fetal growth restriction seems to have led to a decrease in the number of fetuses labeled as growth restricted and to a decrease in the gestational age of delivery of such fetuses, but without increasing the rate of serious neonatal adverse outcomes.
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