OP06.02: Conservative management of low‐risk late fetal growth restriction: an evidence‐based management protocol

Résumé fourni par la source

The aim of this study was to assess the benefit of conservative management at term of late fetal growth restricted (FGR) babies stratified as low risk according with a novel evidence based protocol. Prospective study of women with late FGR recruited at University College London Hospital. Fetuses were singleton, non-anomalous, ≥ 32 weeks, with an estimated weight < 10th centile, or > 10th centile with either umbilical artery Doppler index > 95th centile, cerebroplacental ratio < 5th centile or a decrease in abdominal circumference centile > 50. Pregnancies were classified as low risk if fetal weight was < 10th centile with no Doppler abnormalities or abdominal centile decrease. The low-risk group was delivered by 41 weeks, whilst the high-risk group was delivered at 37 weeks. Primary outcome was adverse neonatal outcome (hypothermia, hypoglycemia, severe jaundice, or neonatal unit admission), secondary outcomes were maternal interventions and abnormal severe neonatal outcome (perinatal mortality, encephalopathy, intubation or inotrope use). Multiple logistic regression was performed. 321 women were recruited (156 were low risk). Low-risk women delivered later (39+5 vs 38+2 weeks, p <0.001) and babies were heavier (2840g vs 2558g, p < 0.001). Low risk women had more spontaneous onset of labour, achieved more unassisted vaginal delivery (48 vs 26%; 31 vs 19% respectively, p < 0.05), and required less emergency Caesarean section even if not reaching significance (22 vs 30%, p = 0.105). Low-risk babies were less likely to have hypothermia (4 vs 15%, p = 0.005), hypoglycemia (3 vs 14%, p = 0.002), severe jaundice (4 vs 13%, p = 0.008), or neonatal unit admission (8 vs 25%, p < 0.001). There were no perinatal deaths and no difference in severe abnormal neonatal outcome. Appropriate risk stratification with conservative management of low risk FGR at term is safe and associated with less adverse neonatal and maternal outcomes.

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