Relationship between abnormal fetal testing and adverse perinatal outcomes in intrauterine growth restriction.
OBJECTIVE
This study was undertaken to compare the efficacy of nonstress test, biophysical profile, or abnormal Dopplers in predicting adverse perinatal outcomes in intrauterine growth restriction.


METHODS
Retrospective cohort study of intrauterine growth restriction (birthweight < fifth percentile for gestation) over a 7-year period. We excluded twins or fetuses with aneuploidy or congenital malformations. Abnormal antenatal testing were defined as: nonstress test that was nonreactive or with significant decelerations, biophysical profile less than or equal to 6, and abnormal Doppler as umbilical artery with absent or reversed end diastolic flow. The outcomes studied included: umbilical artery pH less than 7, respiratory distress syndrome, periventricular leukomalacia, grades 3-4 intraventricular hemorrhage, perinatal mortality, necrotizing enterocolitis, and a composite of at least 1 adverse outcome. Statistical analysis included bivariate and multivariable techniques.


RESULTS
We identified 151 singleton pregnancies with intrauterine growth restriction meeting the inclusion criteria. On bivariate analysis significant variables associated with adverse outcomes were as follows: history of chronic hypertension, corticosteroid administration, and gestational age of delivery. These were adjusted by using logistic regression. The positive predictive values of abnormal Doppler for respiratory distress syndrome and the composite of adverse outcomes were 36% and 42% respectively. Of the testing modalities compared, only abnormal Doppler significantly predicted respiratory distress syndrome and the composite of adverse outcome.


CONCLUSIONS
In cases of intrauterine growth restriction, the presence of abnormal Doppler is the best predictor of adverse perinatal outcome.
Gonzalez
Juan M
JM
Hospital of the University of Pennsylvania and Department of Obstetrics and Gynecology, Philadelphia, PA, USA.
Stamilio
David M
DM
Ural
Serdar
S
Macones
George A
GA
Odibo
Anthony O
AO
D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis*; D005323:Fetal Monitoring; D006801:Humans; D007231:Infant, Newborn; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011296:Prenatal Diagnosis / Q000379:methods*; D012127:Respiratory Distress Syndrome, Newborn / Q000209:etiology*; D012189:Retrospective Studies; D018608:Ultrasonography, Doppler