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Minimum evidence-based care in intrauterine growth-restricted fetuses and neonatal prognosis

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

Abstract

Background

Introduction: There is clear evidence that fetuses with intrauterine growth restriction (IUGR) do not receive the minimum evidence-based care during their antenatal management.

Objective

Considering that optimal management of IUGR may reduce neonatal morbi-mortality in IUGR, the objective of the present study was to evaluate the impact of antenatal management of IUGR according to the recommendations of the French college of gynecologists and obstetricians (CNGOF) on the neonatal prognosis of IUGR fetuses.

Study design

From a historical cohort of 31,052 children, born at the Femme Mère Enfant hospital (Lyon, France) between January 1, 2011 and December 31, 2017, we selected the population of IUGR fetuses. The minimum evidence-based care (MEC) in the antenatal management of fetuses with IUGR was defined according to the CNGOF recommendations and neonatal prognosis of early and late IUGR fetuses were assessed based on the whether or not they received MEC. The neonatal prognosis was defined according to a composite criterion that included neonatal morbidity and mortality.

Results

A total of 1020 fetuses with IUGR were studied. The application of MEC showed an improvement in the neonatal prognosis of early-onset IUGR (p = 0.003), and an improvement in the neonatal prognosis of IUGR born before 32 weeks (p = 0.030). Multivariate analysis confirmed the results showing an increase in neonatal morbi-mortality in early-onset IUGR in the absence of MEC with OR 1.79 (95% CI 1.01–3.19).

Conclusion

Diagnosed IUGR with MEC had a better neonatal prognosis when born before 32 weeks. Regardless of the birth term, MEC improved the neonatal prognosis of fetuses with early IUGR. Improvement in the rate of MEC during antenatal management has a significant impact on neonatal prognosis.

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Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Hospices Civils de Lyon, Femme Mère Enfant Hospital, University Hospital Center, 59 Boulevard Pinel, 69500, Bron, France

    Anthony Atallah, Stéphanie Moret, Mona Massoud, Pascal Gaucherand & Muriel Doret-Dion

  2. Health Services and Performance Research (HESPER) EA 7425, University of Lyon, University Claude Bernard Lyon 1, 69008, Lyon, France

    Anthony Atallah, Pascal Gaucherand & Muriel Doret-Dion

  3. Department of Neonatalogy, Hospices Civils de Lyon, Femme Mère Enfant Hospital, University Hospital Center, 59 Boulevard Pinel, 69500, Bron, France

    Marine Butin & Olivier Claris

  4. International Center for Research in Infectiology, INSERM U1111, CNRS UMR5308, University of Lyon 1, Lyon, France

    Marine Butin

  5. EA 4129, University of Lyon, University Claude Bernard Lyon 1, 69008, Lyon, France

    Olivier Claris

Authors
  1. Anthony Atallah
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  2. Marine Butin
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  3. Stéphanie Moret
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  4. Olivier Claris
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  5. Mona Massoud
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  6. Pascal Gaucherand
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  7. Muriel Doret-Dion
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Contributions

AA: Conceptualization, Methodology, Writing—Original Draft, MB: Writing—Review and Editing. SM: Formal analysis. OC: Writing—Review and Editing, Supervision. MM: Review and Editing. PG: Writing—Review and Editing, Supervision. MD-D: Conceptualization, Methodology, Writing—Review and Editing.

Corresponding author

Correspondence to Anthony Atallah.

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Conflict of interest

All authors declare no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and the national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical approval was given by the Ethics committee of Hospices Civils de Lyon, Pr Jean François GUERIN (n° 20-90).

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Informed consent was obtained from all individual participants included in the study.

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Atallah, A., Butin, M., Moret, S. et al. Minimum evidence-based care in intrauterine growth-restricted fetuses and neonatal prognosis. Arch Gynecol Obstet 305, 1159–1168 (2022). https://doi.org/10.1007/s00404-021-06231-3

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  • DOI: https://doi.org/10.1007/s00404-021-06231-3

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