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Fetal cerebral Doppler changes and outcome in late preterm fetal growth restriction : prospective cohort study

Stampalija, T. (författare)
IRCCS Burlo Garofolo, Inst Maternal & Child Hlth, Unit Fetal Med & Prenatal Diag, Trieste, Italy.;Univ Trieste, Dept Med Surg & Hlth Sci, Trieste, Italy.,University of Trieste,Burlo Garofolo Pediatric Institute
Thornton, J. (författare)
Univ Nottingham, Div Obstet & Gynaecol, City Hosp, Sch Clin Sci,Matern Dept, Nottingham, England.
Marlow, N. (författare)
UCL, UCL Elizabeth Garrett Anderson Inst Womens Hlth, London, England.
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Napolitano, R. (författare)
UCL, UCL Elizabeth Garrett Anderson Inst Womens Hlth, London, England.;Univ Coll London Hosp NHS Fdn Trust, Fetal Med Unit, London, England.
Bhide, A. (författare)
St Georges Univ London, Fetal Med Unit, St Georges Univ Hosp NHS Fdn Trust, London, England.;St Georges Univ London, Mol & Clin Sci Res Inst, London, England.
Pickles, T. (författare)
Cardiff Univ, Coll Biomed & Life Sci, Ctr Trials Res, Cardiff, Wales.
Bilardo, C. M. (författare)
Univ Amsterdam, Amsterdam Univ Med Ctr, Amsterdam Reprod & Dev Res Inst, Dept Obstet & Gynecol, Amsterdam, Netherlands.;Univ Groningen, Univ Med Ctr Groningen, Dept Obstet & Gynaecol, Groningen, Netherlands.
Gordijn, S. J. (författare)
Univ Groningen, Univ Med Ctr Groningen, Dept Obstet & Gynaecol, Groningen, Netherlands.
Gyselaers, W. (författare)
Hasselt Univ, Fac Med & Life Sci, Agoralaan, Diepenbeek, Belgium.;Hasselt Univ, Ziekenhuis Oost Limburg, Dept Obstet & Gynaecol, Diepenbeek, Belgium.;Hasselt Univ, Dept Physiol, Diepenbeek, Belgium.
Valensise, H. (författare)
Tor Vergata Univ, Policlin Casilino Hosp, Div Obstet & Gynecol, Dept Surg, Rome, Italy.
Hecher, K. (författare)
Tor Vergata Univ, Policlin Casilino Hosp, Div Obstet & Gynecol, Dept Surg, Rome, Italy.;Univ Med Ctr Hamburg Eppendorf, Dept Obstet & Fetal Med, Hamburg, Germany.
Sande, R. K. (författare)
Stavanger Univ Hosp, Dept Obstet & Gynecol, Stavanger, Norway.;Univ Bergen, Dept Clin Sci, Bergen, Norway.
Lindgren, P. (författare)
Karolinska Institutet
Bergman, Eva, 1959- (författare)
Uppsala universitet,Obstetrisk och reproduktiv hälsoforskning
Arabin, B. (författare)
Humboldt Univ, Dept Obstet Charite, Berlin, Germany.;Clara Angela Fdn, Berlin, Germany.
Breeze, A. C. (författare)
Leeds Teaching Hosp NHS Trust, Leeds Gen Infirm, Fetal Med Unit, Leeds, W Yorkshire, England.
Wee, L. (författare)
Princess Alexandra Hosp NHS Trust, Harlow, Essex, England.
Ganzevoort, W. (författare)
Univ Amsterdam, Amsterdam Univ Med Ctr, Amsterdam Reprod & Dev Res Inst, Dept Obstet & Gynecol, Amsterdam, Netherlands.
Richter, J. (författare)
Katholieke Univ Leuven, UZ Leuven, Dept Gynecol & Obstet, Leuven, Belgium.;Katholieke Univ Leuven, Dept Regenerat & Dev, Leuven, Belgium.
Berger, A. (författare)
Med Univ Innsbruck, Dept Obstet & Gynecol, Innsbruck, Austria.
Brodszki, Jana (författare)
Lund University,Lunds universitet,Obstetrik och gynekologi, Lund,Sektion V,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Obstetrics and Gynaecology (Lund),Section V,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital
Derks, J. (författare)
Univ Utrecht, Dept Perinatal Med, Utrecht, Netherlands.
Mecacci, F. (författare)
Univ Florence, Obstet & Gynecol, Careggi Univ Hosp, Dept Hlth Sci, Florence, Italy.
Maruotti, G. M. (författare)
Univ Naples Federico II, Dept Neurosci Reprod & Dent Sci, Naples, Italy.
Myklestad, K. (författare)
St Olavs Hosp, Trondheim, Norway.
Lobmaier, S. M. (författare)
Tech Univ Munich, Klinikum Rechts Isar, Dept Obstet & Gynecol, Munich, Germany.
Prefumo, F. (författare)
ASST Spedali Civili Brescia, Dept Obstet & Gynecol, Brescia, Italy.;Univ Brescia, Brescia, Italy.
Klaritsch, P. (författare)
Med Univ Graz, Dept Obstet & Gynecol, Graz, Austria.
Calda, P. (författare)
Charles Univ Prague, Dept Obstet & Gynecol, Gen Univ Hosp, Prague, Czech Republic.;Charles Univ Prague, Fac Med 1, Prague, Czech Republic.
Ebbing, C. (författare)
Haukeland Hosp, Dept Obstet & Gynecol, Bergen, Norway.
Frusca, T. (författare)
Univ Parma, Dept Obstet & Gynecol, Parma, Italy.
Raio, L. (författare)
Univ Hosp Bern, Dept Obstet & Gynecol, Bern, Switzerland.
Visser, G. H. A. (författare)
Univ Med Ctr Utrecht, Div Woman & Baby, Dept Obstet, Utrecht, Netherlands.
Krofta, L. (författare)
Inst Care Mother & Child, Prague, Czech Republic.;Charles Univ Prague, Fac Med 3, Prague, Czech Republic.
Cetin, I. (författare)
Univ Milan, Vittore Buzzi Childrens Hosp, Dept Obstet & Gynecol, Milan, Italy.
Ferrazzi, E. (författare)
Univ Milan, Fdn IRCCS Ca Granda Osped Maggiore Policlin, Dept Obstet & Gynecol, Milan, Italy.;Univ Milan, Dept Clin Sci & Community Hlth, Milan, Italy.
Cesari, E. (författare)
Univ Milan, Vittore Buzzi Childrens Hosp, Dept Obstet & Gynecol, Milan, Italy.
Wolf, H. (författare)
Univ Amsterdam, Amsterdam Univ Med Ctr, Amsterdam Reprod & Dev Res Inst, Dept Obstet & Gynecol, Amsterdam, Netherlands.
Lees, C. C. (författare)
Imperial Coll London, Imperial Coll Sch Med, London, England.;Imperial Coll London, Queen Charlottes & Chelsea Hosp, Dept Fetal Med, London, England.,Imperial College London,Queen Charlotte's and Chelsea Hospital
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IRCCS Burlo Garofolo, Inst Maternal & Child Hlth, Unit Fetal Med & Prenatal Diag, Trieste, Italy;Univ Trieste, Dept Med Surg & Hlth Sci, Trieste, Italy. University of Trieste (creator_code:org_t)
2020-08
2020
Engelska.
Ingår i: Ultrasound in Obstetrics and Gynecology. - : Wiley. - 0960-7692 .- 1469-0705. ; 56:2, s. 173-181
  • Tidskriftsartikel (refereegranskat)
Abstract Ämnesord
Stäng  
  • Objectives To explore the association between fetal umbilical and middle cerebral artery (MCA) Doppler abnormalities and outcome in late preterm pregnancies at risk of fetal growth restriction. Methods This was a prospective cohort study of singleton pregnancies at risk of fetal growth restriction at 32+ 0 to 36+ 6weeks of gestation, enrolled in 33 European centers between 2017 and 2018, in which umbilical and fetal MCA Doppler velocimetry was performed. Pregnancies were considered at risk of fetal growth restriction if they had estimated fetal weight and/or abdominal circumference (AC) < 10th percentile, abnormal arterial Doppler and/or a fall in AC growth velocity of more than 40 percentile points from the 20-week scan. Composite adverse outcome comprised both immediate adverse birth outcome and major neonatal morbidity. Using a range of cut-off values, the association of MCA pulsatility index and umbilicocerebral ratio (UCR) with composite adverse outcome was explored. Results The study population comprised 856 women. There were two (0.2%) intrauterine deaths. Median gestational age at delivery was 38 (interquartile range (IQR), 37-39) weeks and birth weight was 2478 (IQR, 2140-2790) g. Compared with infants with normal outcome, those with composite adverse outcome (n= 93; 11%) were delivered at an earlier gestational age (36 vs 38 weeks) and had a lower birth weight (1900 vs 2540 g). The first Doppler observation of MCA pulsatility index < 5th percentile and UCR Z-score above gestational-age-specific thresholds (1.5 at 32-33weeks and 1.0 at 34-36weeks) had the highest relative risks (RR) for composite adverse outcome (RR 2.2 (95% CI, 1.5-3.2) and RR 2.0 (95% CI, 1.4-3.0), respectively). After adjustment for confounders, the association between UCR Z-score and composite adverse outcome remained significant, although gestational age at delivery and birth-weight Z-score had a stronger association. Conclusion In this prospective multicenter study, signs of cerebral blood flow redistribution were found to be associated with adverse outcome in late preterm singleton pregnancies at risk of fetal growth restriction. Whether cerebral redistribution is a marker describing the severity of fetal growth restriction or an independent risk factor for adverse outcome remains unclear, and whether it is useful for clinical management can be answered only in a randomized trial. (C) 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Reproduktionsmedicin och gynekologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Obstetrics, Gynaecology and Reproductive Medicine (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Radiologi och bildbehandling (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Radiology, Nuclear Medicine and Medical Imaging (hsv//eng)

Nyckelord

adverse outcome
Doppler
middle cerebral artery
neonatal
umbilical artery
umbilicocerebral ratio
adverse outcome
Doppler
middle cerebral artery
neonatal
umbilical artery
umbilicocerebral ratio

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