title: Defining the residual risk of adverse perinatal outcome in growth-restricted fetuses with normal umbilical artery blood flow.
abstract: OBJECTIVE
  We sought to determine the cause of adverse perinatal outcome in fetal growth restriction (FGR) where umbilical artery (UA) Doppler was normal, as identified from the Prospective Observational Trial to Optimize Pediatric Health (PORTO). We compared cases of adverse outcome where UA Doppler was normal and abnormal.
  
  
  METHODS
  The PORTO study was a national multicenter study of >1100 ultrasound-dated singleton pregnancies with an estimated fetal weight <10th centile. Each pregnancy underwent intensive ultrasound, including multivessel Doppler. UA Doppler was considered abnormal when the pulsatility index was >95th centile or end-diastolic flow was absent/reversed. Adverse perinatal outcome was defined as a composite of intraventricular hemorrhage, periventricular leukomalacia, hypoxic ischemic encephalopathy, necrotizing enterocolitis, bronchopulmonary dysplasia, sepsis, or death.
  
  
  RESULTS
  In all, 57 (5.0%) of the 1116 fetuses had an adverse perinatal outcome. Nine (1.3%) of 698 fetuses with normal UA Doppler had an adverse outcome, compared with 48 (11.5%) of 418 with abnormal UA Doppler (P < .0001). There were 2 perinatal deaths in the normal group and 6 in the abnormal group (P = .01). The perinatal deaths in the normal group were 1 case of pulmonary hypoplasia after prolonged preterm rupture of the membranes from 12 weeks' gestation and a case of placental abruption. Gestation at delivery was 33 ± 3 vs 31 ± 4 weeks (P = .05) and mean birthweight was 1830 ± 737 vs 1146 ± 508 g (P = .001) in the respective groups. Neonatal sepsis was the commonest adverse outcome in both groups: 0.1% and 0.4%, respectively (P = .01).
  
  
  CONCLUSIONS
  Adverse perinatal outcome is uncommon in FGR with normal UA Doppler. The cases we identified were associated with heterogenous pathologies. FGR with normal UA blood flow is a largely benign condition.
authors: Department of Obstetrics and Gynecology, Royal College of Surgeons in Ireland, Dublin, Ireland. Electronic address: vickyodwyer@rcsi.ie.
authors: Vicky
authors: V
authors: O'Dwyer
authors: Department of Obstetrics and Gynecology, Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
authors: Gerard
authors: G
authors: Burke
authors: Department of Obstetrics and Gynecology, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors: Julia
authors: J
authors: Unterscheider
authors: Department of Obstetrics and Gynecology, Coombe Women and Infants University Hospital, Dublin, Ireland.
authors: Sean
authors: S
authors: Daly
authors: Department of Obstetrics and Gynecology, Rotunda Hospital, Dublin, Ireland.
authors: Michael P
authors: MP
authors: Geary
authors: University College Dublin Center for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland.
authors: Mairead M
authors: MM
authors: Kennelly
authors: Department of Obstetrics and Gynecology, University College Dublin School of Medicine and Medical Science, National Maternity Hospital, Dublin, Ireland.
authors: Fionnuala M
authors: FM
authors: McAuliffe
authors: Department of Obstetrics and Gynecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland.
authors: Keelin
authors: K
authors: O'Donoghue
authors: Department of Obstetrics and Gynecology, Royal Jubilee Maternity Hospital, Belfast, Ireland.
authors: Alyson
authors: A
authors: Hunter
authors: Department of Obstetrics and Gynecology, National University of Ireland, Galway, Ireland.
authors: John J
authors: JJ
authors: Morrison
authors: Department of Epidemiology and Public Health, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors: Patrick
authors: P
authors: Dicker
authors: Department of Obstetrics and Gynecology, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors: Elizabeth C
authors: EC
authors: Tully
authors: Department of Obstetrics and Gynecology, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors: Fergal D
authors: FD
authors: Malone
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000209:etiology* / Q000401:mortality; D008297:Male; D054238:Perinatal Mortality; D011247:Pregnancy; D011446:Prospective Studies; D011673:Pulsatile Flow; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology*
keywords: adverse perinatal outcome; fetal growth restriction; umbilical artery Doppler