Sonographic surveillance and perinatal outcomes among pregnancies with periviable fetal growth restriction.

Abstract

Objectives: This study compared adverse perinatal outcomes between pregnancies complicated by periviable fetal growth restriction (pFGR) that underwent weekly sonographic surveillance vs. serial growth surveillance.

Methods: In this retrospective cohort study, pFGR was defined as a 22 0/7-27 6/7-week singleton, <500 g, and ≤10 % for gestational age. The surveillance group initiated weekly Doppler surveillance while the serial growth (SG) group underwent growth assessment every 3-4 weeks between 22 and 27 6/7 weeks. Adverse perinatal outcomes were compared.

Results: Eighty-one (36.2 %) underwent weekly Doppler surveillance. Chronic hypertension (18.5 % vs. 9.1 %, p=0.04), a prior history of fetal demise (8.6 % vs. 2.1 %, p=0.02), and an estimated fetal weight <3 % (22.2 % vs. 10.5 %, p=0.02) and any abnormal umbilical artery Doppler pattern at diagnosis (25.8 % vs. 12.9 %, p=0.046) occurred more frequently in the weekly Doppler surveillance group than the SG group. Despite no difference in perinatal death, the surveillance group demonstrated a higher rate of obstetric (65.4 % vs. 42.7 %, p<0.05) and neonatal (60.8 % vs. 28.4 %, p<0.05) adverse outcome composites compared to the SG group.

Conclusions: The surveillance group experienced increased rates of obstetric and neonatal morbidity without difference in perinatal death though interpretation is limited by the observational nature of this study.