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Perinatal outcomes of two consecutive strategies for the management of fetal growth restriction: a before–after study

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

We aim to compare the perinatal outcomes of two consecutive management strategies for fetal growth restriction (FGR), with or without the inclusion of additional Doppler parameters.

Methods

A quasi-experimental before/after study was conducted in which we compared a composite perinatal outcome, prematurity rate, and neonatal complications between two management strategies in small fetuses. In the strategy 1 (S1), the management was based on fetal biometry and umbilical artery Doppler. The second strategy (S2) added the assessment of uterine and middle cerebral artery Doppler. We also compared outcomes between strategies according to early (≤ 32 weeks) and late (> 32 weeks) diagnosis subgroups.

Results

We included 396 patients, 163 in S1 and 233 in S2. There were no significant differences in the perinatal composite outcome (p 0.98), prematurity (p 0.19), or in the subgroup analysis. We found a significant reduction in respiratory distress syndrome (RDS) rate with S2 both globally (OR 0.50, p 0.02), and in the early diagnosis subgroup (OR 0.45, p 0.01). In addition, we observed a significant reduction in the incidence of sepsis with S2 both globally (OR 0.30, p 0.04) and in the early diagnosis subgroup (OR 0.25, p 0.02). We did not observe significant differences in necrotizing enterocolitis (p 0.41) and intraventricular hemorrhage (p 1.00).

Conclusion

The expanded strategy for the management of FGR did not show significant differences in the primary composite outcome or prematurity. However, it was associated with a lower incidence of RDS and neonatal sepsis.

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Acknowledgements

The authors would like to thank Diego Hernan Giunta, Cristina Maria Elizondo, Lucas Otaño, Pablo Hernan Brener, Mariana Leda Bucich, and Maria Lourdes Posadas-Martinez for their valuable contribution to this study.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Universitario Austral, Buenos Aires, Argentina

    Sabrina Paola Demirdjian, Maria Celeste Berruet, Gonzalo Dosdoglirian & Adolfo Etchegaray

  2. Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina

    Cesar Hernan Meller

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  1. Sabrina Paola Demirdjian
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  2. Cesar Hernan Meller
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Contributions

Conceptualization: SPD, AE, and CHM; methodology: SPD and AE; acquisition of data: SPD, GD, and MCB. Formal analysis and investigation: SPD, AE, and CHM; writing—original draft preparation: SPD; writing—review and editing: AE and CM.

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Correspondence to Sabrina Paola Demirdjian.

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The authors have no relevant financial or non-financial interests to disclose.

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The study protocol was approved by our institutional review board.

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Demirdjian, S.P., Meller, C.H., Berruet, M.C. et al. Perinatal outcomes of two consecutive strategies for the management of fetal growth restriction: a before–after study. Arch Gynecol Obstet 307, 319–326 (2023). https://doi.org/10.1007/s00404-022-06641-x

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