Infant outcome after active management of early-onset fetal growth restriction with absent or reverse umbilical artery blood flow.

OBJECTIVE To describe in a retrospective cohort study the short-term and long-term outcomes of all infants with early-onset fetal growth restriction (FGR) and umbilical artery absent (AEDF) or reverse (REDF) end-diastolic flow, delivered before 30 gestational weeks and actively managed at the level 3 perinatal unit in Lund, Sweden between 1998 and 2015. METHODS Outcomes of 139 fetuses with birthweight (BW) small-for-gestational age and ARED flow (FGR group; 26% twins) were compared with those of all infants with BW appropriate-for-gestational age (AGA group; n=946; 28% twins). In the FGR group, the main indication for delivery was the Doppler finding of ARED flow in the umbilical artery. RESULTS FGR infants had a median BW 630 g (range 340-1165) and gestational age at birth 187 days (164-209) as compared to the AGA group with 950 g (470-2194) and 185 days (154-209), respectively. Perinatal mortality did not differ between the two groups (5% and 5.4% in the FGR and AGA group, respectively). All 7 intrauterine deaths in the FGR group occurred before 26 weeks of gestation. Severe intraventricular hemorrhages were less frequent, and bronchopulmonary dysplasia and septicemia more frequent in the FGR group than in the AGA group (p=0.008, p<0.001 and p=0.006, respectively). The survival rate at 2 years (83% of liveborn infants) and rate of cerebral palsy (7%) in the FGR group did not differ from those of AGA group (82% and 8%, respectively). Survival without neurodevelopmental impairment was higher in the AGA group (83%) than in the FGR group (62%) (p<0.001). Within the FGR group, the outcomes between twins and singletons, and between fetuses with AEDF and REDF were similar. CONCLUSIONS Infants born very preterm after severe FGR had similar survival as AGA infants of corresponding gestational age, however, they were at higher risk of neurodevelopmental impairment, the risk being most pronounced following birth before 25 gestational weeks. Gestational age remains an important factor associated with the prognosis of early-onset FGR, nevertheless, the present results support a hypothesis to be prospectively tested that fetuses with umbilical artery ARED flow may benefit from early intervention rather than expectancy and that umbilical artery Doppler findings could be a part of the clinical protocols also in very early gestational weeks. This article is protected by copyright. All rights reserved.