Early Onset Intrauterine Growth Restriction—Data from a Tertiary Care Center in a Middle-Income Country
Abstract
:1. Introduction
2. Materials and Methods
- ○
- In prestage I (defined as EFW between 10th centile and the 3rd centile), we used weekly US monitoring regardless of the GA—amniotic fluid volume assessment (using the deepest vertical pocket technique—DVP [24]), fetal biophysical profile (BPP) [25] and Doppler interrogation at the two fetal sites (UmbA and MCA), the CPR, both UtA and pulsatility index (PI); in this stage, we used US for EFW every two weeks. If the BPP and Dopplers were normal, expectance was proposed until 32 WG, and the case was discarded from the study. If the BPP was abnormal, the case was followed up daily. If there was a persistent abnormal BPP (below 5, two days consecutively), we performed elective C-section before 32 WG, regardless of the Doppler results.
- ○
- In stage I by Figueras [26] (EFW < 3rd centile or CPR < 5th centile or any UtA PI > 95th centile), we offered the same weekly monitoring protocol and the same management. If the BPP was normal, we monitored until we registered the case as advancing toward stage II or until progressing over 32 WG. If the BPP was abnormal, the case was followed up daily. If the BPP was persistently abnormal (below 5, two days consecutively), we added the DV assessment, and we performed an elective C-section before 32 WG regardless of the Doppler results.
- ○
- In stage II by Figueras [26]—defined as UmbA absent end-diastolic velocity (AEDV)—we offered hospitalization. If the parents declined admittance, we re-examined twice a week. Inpatients were also offered twice-weekly additional cardiotocography (CTG) and DV assessment daily. In this stage, we performed an elective C-section before 32 WG in all cases.
- ○
- In stage III by Figueras [26]—defined as UmbA reversed end-diastolic velocity (REDV), we monitored cases by US daily. In surviving fetuses, we offered delivery by cesarean section before 30 weeks based on the DV assessment.
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- In stage IV by Figueras [26]—defined as reversed flow ductus venosus (DV), we offered immediate delivery after 27 weeks by caesarean section to all couples. Benefits and expectations were extensively explained to the parents in these cases.
Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Characteristics | susp Early IUGR | Control | p |
---|---|---|---|
Smoking/former smoker | 66.67% | 21.4% | <0.01 |
Age | 29.17 (19–37) | 27.17 (18–35) | 0.053 |
BMI | 24.5 (19–27) | 27.0 (17–31) | 0.374 |
Variable | susp Early IUGR | Control | p |
---|---|---|---|
Nr of prenatal visits | 11.5 (10–30) | 5 (5–6) | <0.01 |
Nr of prenatal visits in the TT | 6 (5–15) | 2 (1–3) | <0.01 |
Characteristic/Complications | susp Early IUGR | Controls | p |
---|---|---|---|
Hospitalization days | 36 (22–90) | 3.8 (2–5) | <0.01 |
Apgar Score | 5.5 (1–8) | ||
Resuscitation | 17 (47.2%) | ||
Birth percentile | 1% (1–10%) | ||
NICU days | 10.5 (0–60) | ||
Respiratory Distress Syndrome | 20 (55.5%) | ||
Bronchopulmonary Dysplasia | 1 (2.7%) | ||
Transient Apnea | 36 (100%) | ||
Hypotension | 4 (11.1%) | ||
PDA | 15 (41.6%) | ||
IVH | 6 (16.6%) | ||
PVL | 2 (5.5%) | ||
Hypothermia | 0 | ||
Immature GI System | 32 (88.8%) | ||
NEC | 1 (2.7%) | ||
Anemia | 36 (100%) | ||
Jaundice | 10 (27.7%) | ||
Transient Hypoglycaemia | 16 (44.4%) | ||
Infection | 9 (25%) |
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Dinu, M.; Badiu, A.M.; Hodorog, A.D.; Stancioi-Cismaru, A.F.; Gheonea, M.; Grigoras Capitanescu, R.; Sirbu, O.C.; Tanase, F.; Bernad, E.; Tudorache, S. Early Onset Intrauterine Growth Restriction—Data from a Tertiary Care Center in a Middle-Income Country. Medicina 2023, 59, 17. https://doi.org/10.3390/medicina59010017
Dinu M, Badiu AM, Hodorog AD, Stancioi-Cismaru AF, Gheonea M, Grigoras Capitanescu R, Sirbu OC, Tanase F, Bernad E, Tudorache S. Early Onset Intrauterine Growth Restriction—Data from a Tertiary Care Center in a Middle-Income Country. Medicina. 2023; 59(1):17. https://doi.org/10.3390/medicina59010017
Chicago/Turabian StyleDinu, Marina, Anne Marie Badiu, Andreea Denisa Hodorog, Andreea Florentina Stancioi-Cismaru, Mihaela Gheonea, Razvan Grigoras Capitanescu, Ovidiu Costinel Sirbu, Florentina Tanase, Elena Bernad, and Stefania Tudorache. 2023. "Early Onset Intrauterine Growth Restriction—Data from a Tertiary Care Center in a Middle-Income Country" Medicina 59, no. 1: 17. https://doi.org/10.3390/medicina59010017