title: Risk of perinatal death in early-onset intrauterine growth restriction according to gestational age and cardiovascular Doppler indices: a multicenter study.
abstract: OBJECTIVE
  To assess the value of gestational age and cardiovascular Doppler indices in predicting perinatal mortality in a multicenter cohort of early-onset intrauterine growth-restricted (IUGR) fetuses.
  
  
  METHODS
  A multicenter prospective cohort study including 157 early-onset (<34 weeks) IUGR cases with abnormal umbilical artery (UA) Doppler was conducted. Cardiovascular assessment included the ductus venosus (DV), the aortic isthmus flow index (IFI), and the myocardial performance index (MPI). Isolated and combined values to predict the risk of perinatal death were evaluated by logistic regression and by decision tree analysis, where the gestational age at delivery, UA, and middle cerebral artery (MCA) were also included as covariates.
  
  
  RESULTS
  Perinatal mortality was 17% (27/157). All parameters were significantly associated with perinatal death, with individual odds ratios (OR) of 25.2 for gestational age below 28 weeks, 12.1 for absent/reversed DV atrial flow, 5.3 for MCA pulsatility index <5th centile, 4.6 for UA absent/reversed diastolic end-flow, 1.8 for IFI <5th centile, and 1.6 for MPI >95th centile. Decision tree analysis identified gestational age at birth as the best predictor of death (<26 weeks, 93% mortality; 26-28 weeks, 29% mortality, and >28 weeks, 3% mortality). Between 26 and 28 weeks, DV atrial flow allowed further stratification between high (60%) and low risk (18%) of mortality.
  
  
  CONCLUSIONS
  Gestational age largely determines the risk of perinatal mortality in early-onset IUGR before 26 weeks and later than 28 weeks of gestation. The DV may improve clinical management by stratifying the probability of death between 26 and 28 weeks of gestation.
authors: Department of Maternal-Fetal Medicine (Institut Clínic de Ginecologia, Obstetrícia i Neonatologia), Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, and Centro de Investigación Biomédica en Red de Enfermedades Raras, Barcelona, Spain.
authors: Mónica
authors: M
authors: Cruz-Lemini
authors: Fàtima
authors: F
authors: Crispi
authors: Tim
authors: T
authors: Van Mieghem
authors: Daniel
authors: D
authors: Pedraza
authors: Rogelio
authors: R
authors: Cruz-Martínez
authors: Ruthy
authors: R
authors: Acosta-Rojas
authors: Francesc
authors: F
authors: Figueras
authors: Mauro
authors: M
authors: Parra-Cordero
authors: Jan
authors: J
authors: Deprest
authors: Eduard
authors: E
authors: Gratacós
mesh_terms: D001011:Aorta / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000196:embryology / Q000503:physiopathology; D001530:Belgium / Q000453:epidemiology; D002677:Chile / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D047109:Fetal Development; D005317:Fetal Growth Retardation / Q000401:mortality* / Q000503:physiopathology*; D005865:Gestational Age; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008137:Longitudinal Studies; D020768:Middle Cerebral Artery / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000196:embryology / Q000503:physiopathology; D011247:Pregnancy; D011446:Prospective Studies; D012306:Risk; D013030:Spain / Q000453:epidemiology; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000002:abnormalities* / Q000000981:diagnostic imaging* / Q000196:embryology / Q000503:physiopathology; D014652:Vascular Diseases / Q000000981:diagnostic imaging* / Q000196:embryology / Q000209:etiology* / Q000503:physiopathology