Determination of the ideal timing of delivery among growth- restricted fetuses at less than 32 weeks age of gestation using a stage-based doppler protocol for admitted patients at the Philippine Children’s Medical Center.
- Author:
Ma. Theresa Acosta Muldong
;
Maria Estrella Yu Flores
- Publication Type:Journal Article
- Keywords:
Early Onset Fetal Growth Restriction;
Doppler Staging;
Ideal Timing of Delivery;
Uteroplacental Insufficiency
- From:
The Philippine Children’s Medical Center Journal
2023;19(1):1-13
- CountryPhilippines
- Language:English
-
Abstract:
OBJECTIVES:Early onset fetal growth restriction substantially contributes to neonatal mor-bidities and mortalities. The main dilemma lies on the timing of delivery, especially for pre- and
peri-viable fetuses, due to the challenge in creating an ideal balance of minimized in-utero hy-
poxia-induced fetal injury or death versus the risks of iatrogenic preterm delivery. We wished to
determine the ideal timing of delivery among growth-restricted fetuses <32 weeks gestation us-
ing a stage-based doppler protocol.
MATERIALS AND METHODS:A retrospective-cohort study of 67 singleton-pregnant wom-
en with growth restriction at <32 weeks gestation and hospitalized from January 2010 to Sep-
tember 2021 was conducted. Medical records were reviewed, and the outcomes were extracted.
The primary outcomes were arterial pH at birth and mortality, while secondary outcomes includ-
ed neonatal morbidities.
RESULTS:Fetal growth restriction progressed by an average of 3 stages (41.79%) within a 2-
to 3.5-week period. More than half had arterial pH <7.20, which was lowest at Stage II FGR
(50.00%). The prevalence of neonatal
mortality was 16.42% and was lowest at Stage I (8.70%) and Stage II FGR (18.75%).
CONCLUSION:Doppler studies may be conducted weekly for Stage I, biweekly for Stage II,
every 1-2 days for Stage III and every 12 hours for Stage IV. Delivery is ideal at Stage II as this
resulted in the least number of acidosis and neonatal mortalities.
- Full text:Determination of the ideal timing of delivery among growth- restricted fetuses at less than 32 weeks age of gestation using a stage-based doppler protocol for admitted patients at Philippine Children’s Medical Center.pdf
