![]() This might be explained by a combination of causes, which could include the low tolerance of term fetuses to hypoxia and episodes of rapid placental function failure. If not diagnosed, late FGR may undergo rapid deterioration leading to severe injury or perinatal death without observable late-stage signs. Integrated fetal testing is fundamental to detect significant variations in the clinical evolution of late-onset FGR, to accurate schedule fetal surveillance and to make decisions on delivery timing.ĭiagnosis of late FGR involves the integration of Doppler ultrasound data and Fetal Heart Rate (FHR) monitoring through computer assisted (or computerized) CardioTocoGraphy (cCTG The cCTG represents a quantitative technological approach of classical visual inspection CTG, by which FHR and Toco parameters can be extracted through computer analysis: it has largely been employed for fetal well-being assessment during the antenatal period, especially in pregnancies complicated by FGR. Clinical evolution of fetal deterioration may include a reduction in amniotic fluid volume and non-reassuring cardiotocography (CTG). Sometimes, it is possible to recognize a chronological evolution of fetal Doppler abnormalities with Umbilical Artery (UA) PI increase, Middle Cerebral Artery (MCA) PI reduction or a co-occurrence of both events. It is frequently associated with mild placental perfusion and moderate fetal Doppler Pulsatility Index (PI) abnormalities. ![]() The late-onset FGR condition represents the 70–80% of FGR cases. This approach identifies a third of FGR infants or fewer and unidentified FGR is a common finding in perinatal deaths. Third trimester obstetrical ultrasound policies differ from country to country, usually women are not routinely scanned in late pregnancy but are selected for third trimester ultrasonography on the basis of pre-pregnancy risk factors, development of obstetric complications, and serial measurement of symphyseal-fundal height. Although potential abnormalities in placental development may arise over the continuum of gestational age, common opinion distinguished the early-onset presenting before 32 weeks from the late-onset FGR presenting after 32 weeks. FGR evolves from a preclinical phase to clinically apparent growth delay and may ultimately progress to fetal deterioration. The key issue in the management of a pregnancy complicated by FGR is the timely identification of the fetus at greatest risk for adverse outcome. ![]() The prevalence is estimated to affect approximately 3–9% of all pregnancies, according to different definition used. Trial registrationįetal growth restriction (FGR), also known as intrauterine growth restriction (IUGR) is a common complication of pregnancy that has been associated with a variety of adverse perinatal outcomes. The results of this study show the contribution of advanced cCTG parameters and fetal Doppler to the identification of late FGR and the association of those parameters with the risk for NICU admission. ![]() Values of STV, Delta, APRS, DPRS were significantly lower for FGR neonates admitted to NICU, compared with the uncomplicated FGR cohort. STV and DPRS were the only parameters to be found different when stratifying by (UA_PI >95th centile or UA_PI 95th centile while, the accuracy attributable to the prediction of MCA_PI was 0.76, 0.77, 0.73, and 0.76 for STV, Delta, APRS, and DPRS, respectively.Īn association of UA_PI>95th centile and MCA_PI<5th centile with higher risk for NICU admission, was observed, while CPR < 5th centile resulted not associated with any perinatal outcome. In the FGR cohort, Delta, STV, APRS, and DPRS were found different when stratifying by MCA_PI (MCA_PI 5th centile). ResultsĪmong the extracted cCTG parameters, Delta Index, Short Term Variability (STV), Long Term Variability (LTV), Acceleration and Deceleration Phase Rectified Slope (APRS, DPRS) values were lower in the late FGR participants compared to the control group. Two hundred forty-nine pregnant women fulfilling the inclusion criteria were enrolled in the study 95 were confirmed as late FGR and 154 were included in the control group. Only pregnant women who had the last Doppler measurement obtained within 1 week before delivery and cCTG performed within 24 h before delivery were included in the study. The study was conducted from January 2018 to May 2020. The aim of the study was to evaluate the diagnostic power of combined Doppler and cCTG parameters by contrasting late FGR –and healthy controls. The clinical diagnosis of late Fetal Growth Restriction (FGR) involves the integration of Doppler ultrasound data and Fetal Heart Rate (FHR) monitoring through computer assisted computerized cardiotocography (cCTG).
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