Fetal Growth Restrition with Neonatal admission A Retrospective Study

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Fetal Growth Restrition with Neonatal admission
A Retrospective Study

• Marta Sobral, João Alves, Susana Maia, Leonor
  Ferreira, Carolina Oliveira,
• Natália Cruces, Ivone Lobo, Maria José Castro,
  João Dias, Olga Viseu
• Obstetrics Department, Hospital de Faro

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Introduction

• Fetal Growth Restrition (FGR)
• Estimated weight inferior to 10th percentil for
  gestacional age
• 53 of pre-term newborn
• 26 of term newborn
• 2nd place in peri-natal mortality

Gabbe, Obstetrics Normal and Problem
Pregnancies, Elsevier, 2008
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Introduction

• Essencial to evaluate clinical practice to
  improve outcomes in FGR
• Retrospective study in Obstetrics Department
  (Hospital de Faro) to evaluate cases of Fetal
  Growth Restrition that needed admission in
  Neonatal Intensive Care Unit

• Risk factors
• Identification
• Clinical follow-up
• Interventions
• Neonatal outcomes

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Methods

• 1 Identification of the newborn with Fetal
  Growth Restrition admitted in the Neonatal
  Intensive Care Unit (NICU) during the year 2008
• weight
• Gestational age at labour

lt 10th Percentil
Fenton TR, BMC Pediatr 2003 Dec 163(7)13
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Methods
2 Retrospective evaluation of clinical charts
of the mothers

• Maternal Age
• Parity
• Pregnancy follow-up
• Toxics smoking, drugs

• Congenital infections, placental patology or
  fetal patology
• Gestational Age on diagnosis of FGR
• Type of FGR
• Amniotic Fluid
• Doppler Study

• Gestational Age at delivery
• Delivery
• Birth weight
• Apgar
• Reason for admission on NICU

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Results

• 2008 cases of Fetal Growth Restrition
• N72
• 2,3 of 3125 births in our hospital in 2008

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Results
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Results

• Cases of FGR admitted at NICU, 2008
• N28 (1 case of twins)
• 1 of 3125 birth in our hospital in 2008
• 57,1 preterm

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Results

• Mothers
• Median age 30,9 anos (19-39)
• Mostly primipara

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Results

• Mothers
• 5 cases with lt than 3 pre-natal appointments
  (18)
• 5 cases of smoking pregnant woman (18)
• 2 cases of ev drug abuse (7,2)

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Results

• FGR Diagnosis
• Median gestational age 35 weeks
• 6 cases lt 5th Percentile

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Results

• Type and cause of FGR

• Identified causes of FGR during pregnancy
• Congenital infections
• 1 case of CMV infection
• Placentar patology
• 1 case of a single umbilical artery
• Fetal Patology
• 2 cases of cardiac malformation

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Results

• Doppler alterations in 18
• Oligoamnios in 25

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Results

• Delivery
• Median gestational age 36 weeks
• Most frequent cesarian section

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Results

• New-borns
• 10 with lt 1500g (36)
• Apgar between 5 and 10 no peripartum mortality

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Results

• Diagnosis of NICU admitted new-born

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Discussion

• Globally, cases of FGR less than bibliography
• Reference appointment for fetal growth
  evaluation, 35 weeks
• 75 of pregnant women with delivery at our
  hospital attended at least 1 appointment on Faro
  Hospital
• Smoking, gt30 year-old, pregnant women are at risk
• Better results with early identification
• Consider using growth curves also on low risk
  population
• Folow-up
• Ultrasound (AC, AF) , doppler on selected cases

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Discussion

• High rate of C-sections
• Depending on gestational age and fetal commitment
• Liberization of C-section on FGR
• Prostaglandins careful on inducing labour on
  fetus with FGR
• Continuous monitorization

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Conclusion

• Priority prevent fetal/neonatal deaths because
  of fetal growth restrition
• Identify risk factors
• Identify cases os FGR
• Carefully plan of prenatal care and delivery
• Evaluate regularly our work on this area, to
  improve health care

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Bibliography

• American College of Obstericians and
  gynecologists ACOG Practice Bulletin
  Intrauterine Growth Restrition Number 12, 2000
• Garite TJ, et al, Intrauterine growth restrition
  increases morbidity and mortality among premature
  neonates. Am J Obstet Gynecol 2004 191481-487
• Wolfe HM, Gross TL, Sokol RJ Recurrent small for
  gestational age birth perinatal risks and
  outcomes. Am J Obstet Gynecol 157288, 1987.
• Gardosi J, Mul T, Mongelli M, Fagan D Analysis
  of birthweight and gestational age in antepartum
  stillbirths. Br J Obstet Gynaecol 105524, 1998.
• Billardo CM, et al, Relationship between
  monitoring parameters and perinatal outcome in
  severe, early intrauterine growth restrition.
  Ultrasoun Obst Gynecology 2001 18 571-577
• Gabbe, Obstetrics Normal and Problem
  Pregnancies, Elsevier, 2008