title: Short-term outcome of periviable small-for-gestational-age babies: is our counseling up to date?
abstract: OBJECTIVE
  There are limited data for counseling on and management of periviable small-for-gestational-age (SGA) fetuses. We therefore aimed to investigate the short-term outcome of periviable SGA fetuses in relation to the likely underlying cause.
  
  
  METHODS
  This was a retrospective study of data from three London tertiary fetal medicine centers obtained between 2000 and 2015. We included viable singleton pregnancies with a severely small fetus, defined as those with an abdominal circumference ≤ 3rdpercentile, identified between 22 + 0 and 25 + 6 weeks' gestation. Data obtained included fetal biometry, presence of placental anomalies, uterine and fetal Doppler and neonatal outcome. We excluded cases with structural abnormalities, proven or suspected abnormal karyotype or genetic syndromes. Cases were classified according to the suspected underlying cause of the small fetal size into one of the following categories: uteroplacental insufficiency, evidence of placental damage with normal uterine artery Doppler, viral infection, or unclassied.
  
  
  RESULTS
  There were 245 cases included in the study. Of these, at diagnosis of SGA, 201 (82%) were categorized as uteroplacental cause, 13 (5%) as suspected placental cause, one (0.4%) as suspected viral cause and 30 (12%) could not be assigned to any of these categories. Overall, 101 (41%) cases survived the neonatal period; 89 (36%) underwent in-utero fetal demise, 22 (9%) died neonatally and 33 (14%) pregnancies were terminated. The diagnosis-to-delivery interval was 8.1 weeks in those that survived and 4.5 weeks in those that died neonatally.
  
  
  CONCLUSIONS
  Almost 90% of periviable SGA cases are associated with uteroplacental insufficiency or intraplacental damage. Survival is related to gestational age at delivery, with outcomes better than might be assumed at diagnosis and some pregnancies reaching term. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
authors.affiliation: Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare, London, UK.
authors.forename: A R
authors.initials: AR
authors.lastname: Lawin-O'Brien
authors.affiliation: Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare, London, UK.|Department of Obstetrics and Gynaecology, University of Parma, Parma, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Dall'Asta
authors.affiliation: Department of Obstetrics and Gynaecology, Guy's and St Thomas' Hospital Foundation Trust, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Knight
authors.affiliation: Department of Obstetrics and Gynaecology, Guy's and St Thomas' Hospital Foundation Trust, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Sankaran
authors.affiliation: Fetal Medicine Unit, St George's Hospital, University of London, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Scala
authors.affiliation: Fetal Medicine Unit, St George's Hospital, University of London, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Khalil
authors.affiliation: Fetal Medicine Unit, St George's Hospital, University of London, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Bhide
authors.affiliation: Department of Neonatology, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Heggarty
authors.affiliation: Department of Neonatology, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Rakow
authors.affiliation: Women's Health Academic Centre, Division of Women's Health, King's Health Partners Biomedical Research Centre, King's College London, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Pasupathy
authors.affiliation: Fetal Medicine Unit, St George's Hospital, University of London, London, UK.
authors.forename: A T
authors.initials: AT
authors.lastname: Papageorghiou
authors.affiliation: Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare, London, UK.|Department of Surgery and Cancer, Imperial College London, London, UK.|Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
authors.forename: C C
authors.initials: CC
authors.lastname: Lees
mesh_terms: D003376:Counseling; D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis* / Q000209:etiology; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D010927:Placental Insufficiency / Q000453:epidemiology*; D011247:Pregnancy; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D018608:Ultrasonography, Doppler / Q000379:methods*; D016216:Ultrasonography, Prenatal / Q000379:methods*
keywords: antenatal counseling; fetal complications; iatrogenic preterm delivery; intrauterine growth restriction; neonatal intensive care unit; periviable SGA