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Published on: June 29, 2013
The TRUFFLE monitoring protocol for early-onset fetal growth restriction: A clinical effectiveness study
Claire Pegorie1, Basia Chmielewska1, Michelle Jie1
1Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK.
Insights
The TRUFFLE monitoring protocol effectively manages preterm fetal growth restriction (FGR) in routine care, achieving high neonatal survival rates. Integrating Doppler and computerized CTG monitoring is key for timely delivery decisions in early FGR.
Area of Science:
- Perinatal Medicine
- Fetal Monitoring
- Maternal-Fetal Medicine
Background:
- The TRUFFLE study demonstrated the efficacy of a specific monitoring protocol for preterm fetal growth restriction (FGR).
- Assessing the clinical effectiveness of this protocol in a real-world setting is essential for optimizing patient outcomes.
- This study evaluates the TRUFFLE protocol's impact on clinical outcomes in routine FGR management.
Purpose of the Study:
- To evaluate the clinical effectiveness of the TRUFFLE monitoring protocol for preterm fetal growth restriction (FGR) in a routine clinical setting.
- To assess overall and stratified perinatal outcomes, including survival and delivery timing.
- To compare outcomes based on gestational age at FGR diagnosis.
Main Methods:
- Retrospective cohort study of singleton pregnancies with preterm FGR (Jan 2013 - Jul 2024).
- FGR defined by estimated fetal weight/abdominal circumference <10th centile and elevated umbilical artery pulsatility index >95th centile.
- Key outcomes: perinatal survival, interval from diagnosis to delivery, delivery indications.
Main Results:
- 171 pregnancies included; median gestation at diagnosis 27+6 weeks, at birth 30+3 weeks.
- Intact neonatal survival was 90.6%; stillbirth rate 2.9%, neonatal death rate 5.8%.
- Early FGR diagnosis (<26 weeks) led to longer intervals to birth (31 days vs. 10-14 days). Abnormal CTG with low STV predominated delivery indication before 32 weeks; Doppler/maternal indications post-32 weeks.
Conclusions:
- The TRUFFLE monitoring protocol is effective for managing early-onset FGR in clinical practice, yielding outcomes comparable to the RCT.
- Routine integration of Doppler and computerized CTG monitoring is vital for optimizing delivery timing in early FGR.
- Further research into more frequent or remote fetal monitoring strategies is warranted.
Introduction:
The randomized control Trial (RCT) of Randomized Umbilical and Fetal Flow in Europe (TRUFFLE study) established its clinical efficacy for monitoring preterm fetal growth restriction (FGR). The objective of this study was to assess the clinical effectiveness of this protocol in a routine clinical setting with regards to the clinical outcomes, both overall and stratified by gestational age at FGR diagnosis.
Material And Methods:
This is a retrospective cohort study of singleton pregnancies with preterm FGR between January 2013 and July 2024 in a tertiary Fetal Medicine Unit. FGR was defined as an estimated fetal weight or abdominal circumference <10th centile with an elevated umbilical artery pulsatility index >95th centile. Main outcomes collected included perinatal survival, interval from diagnosis to delivery, and delivery indications.
Results:
171 pregnancies met inclusion criteria. The median (IQR) gestation at FGR diagnosis and birth was 27+6 (25+5-29+4) and 30+3 (28+0-32+4) weeks, respectively. Overall intact neonatal survival was 90.6%, with the rate of stillbirth and neonatal death being 2.9% and 5.8%, respectively. FGR diagnosis prior to 26 weeks was associated with a three-fold longer interval to birth compared with FGR diagnosis at 26+0-29+6 and ≥30 weeks (median of 31.0 vs. 10.0 and 14.0 days; p < 0.001). Below 32 weeks, the predominant indication for elective birth was abnormal computerized CTG with low short-term variation (STV). Beyond 32 weeks' gestation, abnormal umbilical artery Doppler and maternal indications such as preeclampsia were more frequent.
Conclusions:
The TRUFFLE monitoring protocol is clinically effective in managing early-onset FGR outside a trial environment, achieving comparable perinatal outcomes to the original RCT. Routine integration of both Doppler and cCTG monitoring is crucial for optimal timing of birth with early FGR. Further research is needed to explore the benefits of more frequent or remote fetal monitoring.
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