Outcome in early-onset fetal growth restriction is best combining computerized fetal heart rate analysis with ductus venosus Doppler: insights from the Trial of Umbilical and Fetal Flow in Europe
| Autor: | Neil Marlow, Aleid G. van Wassenaer-Leemhuis, Baskaran Thilaganathan, Kurt Hecher, Johannes J. Duvekot, Tullia Todros, E. Ostermayer, Jim G Thornton, J. W. Ganzevoort, Birgit Arabin, Gerard H. A. Visser, Dietmar Schlembach, Aris T. Papageorghiou, Tiziana Frusca, Christoph Brezinka, Christoph Lees, Caterina M. Bilardo, Hans Wolf, Herbert Valensise, Enrico Ferrazzi, Karel Marsal, Anke Diemert, Jan Derks, Pasquale Martinelli |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Biophysical profile
Trial of Umbilical and Fetal Flow in Europe Middle Cerebral Artery Umbilical Veins Cardiotocography Intrauterine growth restriction law.invention 0302 clinical medicine Randomized controlled trial law Pregnancy Heart Rate 1114 Paediatrics And Reproductive Medicine Laser-Doppler Flowmetry Medicine Birth Weight Prenatal 030212 general & internal medicine GESTATION PREDICTORS Randomized Controlled Trials as Topic Ultrasonography RISK 030219 obstetrics & reproductive medicine Fetal Growth Retardation medicine.diagnostic_test Obstetrics Doppler Obstetrics and Gynecology Disease Management Heart Rate Fetal perinatal outcome Settore MED/40 Pregnancy Trimester Second Pulsatile Flow Gestation Premature Birth Female Pregnancy Trimester Acidosis INTERVENTION Delivery Ductus venosus medicine.medical_specialty Fetal Heart Rate Variability intrauterine growth restriction Pregnancy Trimester Third neurodevelopmental handicap PARAMETERS Ultrasonography Prenatal Fetal 03 medical and health sciences AGE BIOPHYSICAL PROFILE FETUSES Humans Obstetrics & Reproductive Medicine Fetal Death ARTERY Third Fetus umbilical artery Doppler business.industry Ultrasonography Doppler Obstetric Second Delivery Obstetric medicine.disease antepartum surveillance cardiotocography NEONATAL MORBIDITY business |
| Zdroj: | S789 S783 TRUFFLE investigators 2018, ' Outcome in early-onset fetal growth restriction is best combining computerized fetal heart rate analysis with ductus venosus Doppler : insights from the Trial of Umbilical and Fetal Flow in Europe ', American Journal of Obstetrics and Gynecology, vol. 218, no. 2, pp. S783-S789 . https://doi.org/10.1016/j.ajog.2017.12.226 |
| DOI: | 10.1016/j.ajog.2017.12.226 |
| Popis: | Background: Early-onset fetal growth restriction represents a particular dilemma in clinical management balancing the risk of iatrogenic prematurity with waiting for the fetus to gain more maturity, while being exposed to the risk of intrauterine death or the sequelae of acidosis. Objective: The Trial of Umbilical and Fetal Flow in Europe was a European, multicenter, randomized trial aimed to determine according to which criteria delivery should be triggered in early fetal growth restriction. We present the key findings of the primary and secondary analyses. Study Design: Women with fetal abdominal circumference 95th percentile between 26-32 weeks were randomized to 1 of 3 monitoring and delivery protocols. These were: fetal heart rate variability based on computerized cardiotocography; and early or late ductus venosus Doppler changes. A safety net based on fetal heart rate abnormalities or umbilical Doppler changes mandated delivery irrespective of randomized group. The primary outcome was normal neurodevelopmental outcome at 2 years. Results: Among 511 women randomized, 362/503 (72%) had associated hypertensive conditions. In all, 463/503 (92%) of fetuses survived and cerebral palsy occurred in 6/443 (1%) with known outcome. Among all women there was no difference in outcome based on randomized group; however, of survivors, significantly more fetuses randomized to the late ductus venosus group had a normal outcome (133/144; 95%) than those randomized to computerized cardiotocography alone (111/131; 85%). In 118/310 (38%) of babies delivered |
| Databáze: | OpenAIRE |
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