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Observational Study
. 2023 Apr;130(5):485-493.
doi: 10.1111/1471-0528.17181. Epub 2022 Jun 1.

Death and severe morbidity in isolated periviable small-for-gestational-age fetuses

Eva Meler  1 , Edurne Mazarico  2   3 , Anna Peguero  1 , Alba Gonzalez  2 , Judit Martinez  1 , David Boada  1 , Killian Vellvé  1 , Gemma Arca  4   5 , Maria Dolores Gómez-Roig  2   3 , Eduard Gratacós  1 , Francesc Figueras  1
Affiliations
Observational Study

Death and severe morbidity in isolated periviable small-for-gestational-age fetuses

Eva Meler et al. BJOG. 2023 Apr.

Abstract

Objective: This study aims to predict perinatal death or severe sequelae in isolated small-for-gestational-age fetuses, diagnosed at a periviable gestational age, based on ultrasound and Doppler parameters at diagnosis.

Design: Observational study.

Setting: A tertiary perinatal centre.

Population: A cohort of singleton non-malformed fetuses suspected to be small for gestational age (estimated fetal weight, EFW, <10th centile) diagnosed at 22.0-25.6 weeks of gestation. The following parameters were recorded at diagnosis: severe smallness (<3rd centile); absent or reversed end-diastolic velocity in umbilical artery; abnormal middle cerebral artery Doppler; abnormal cerebroplacental ratio; abnormal uterine artery Doppler; and absent or reversed end-diastolic velocity in the ductus venosus.

Methods: Logistic regression analysis.

Main outcome measures: Predictive performance of EFW and Doppler parameters for short-term adverse outcome of perinatal morbimortality and composite serious adverse outcomes (death, neurological impairment or severe bronchopulmonary dysplasia).

Results: A total of 155 pregnancies were included. There were 13 (8.4%) intrauterine and 11 (7.7%) neonatal deaths. A short-term adverse perinatal outcome occurred in 40 (25.8%) pregnancies. There were 31 (20%) cases of serious adverse outcomes. For the prediction of serious adverse outcomes, the combination of absent or reversed end-diastolic velocity in the umbilical artery and impaired middle cerebral artery detected by Doppler evaluation achieved a detection rate of 87%, with a false-positive rate of 14% (accuracy 86%).

Conclusion: In periviable isolated small-for-gestational-age fetuses, a Doppler evaluation of the umbilical and fetal brain circulation can accurately predict short-term adverse perinatal complications and serious adverse outcomes.

Keywords: fetal growth restriction; neonatal complications; neurological impairment; perinatal mortality; placental insufficiency; small for gestational age.

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