Early Onset Intrauterine Growth Restriction-Data from a Tertiary Care Center in a Middle-Income Country.
Marina Dinu, Anne Marie Badiu, Andreea Denisa Hodorog, Andreea Florentina Stancioi-Cismaru, Mihaela Gheonea, Razvan Grigoras Capitanescu, Ovidiu Costinel Sirbu, Florentina Tanase, Elena Bernad, Stefania Tudorache
Author Information
Marina Dinu: 8th Department, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
Anne Marie Badiu: 1st Department, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
Andreea Denisa Hodorog: Obstetrics and Gynecology Department, Mioveni City Hospital, 115400 Mioveni, Romania.
Andreea Florentina Stancioi-Cismaru: Obstetrics and Gynecology Department, Emergency County Hospital, 200349 Craiova, Romania.
Mihaela Gheonea: 8th Department, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
Razvan Grigoras Capitanescu: 8th Department, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
Ovidiu Costinel Sirbu: 8th Department, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
Florentina Tanase: 8th Department, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
Elena Bernad: Obstetrics and Gynecology Department, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania. ORCID
Stefania Tudorache: 8th Department, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania. ORCID
Background and Objectives: In this study, we aimed to describe the clinical and ultrasound (US) features and the outcome in a group of patients suspected of or diagnosed with early onset intrauterine growth restriction (IUGR) requiring iatrogenic delivery before 32 weeks, having no structural or genetic fetal anomalies, managed in our unit. A secondary aim was to report the incidence of the condition in the population cared for in our hospital, data on immediate postnatal follow-up in these cases and to highlight the differences required in prenatal and postnatal care. Materials and Methods: We used as single criteria for defining the suspicion of early IUGR the sonographic estimation of fetal weight < p10 using the Hadlock 4 technique at any scan performed before 32 weeks’ gestation (WG). We used a cohort of patients having a normal evolution in pregnancy and uneventful vaginal births as controls. Data on pregnancy ultrasound, characteristics and neonatal outcomes were collected and analyzed. We hypothesized that the gestational age (GA) at delivery is related to the severity of the condition. Therefore, we performed a subanalysis in two subgroups, which were divided based on the GA at iatrogenic delivery (between 27+0 WG and 29+6 WG and 30+0−32+0 WG, respectively). Results: The prospective cohort study included 36 pregnancies. We had three cases of intrauterine fetal death (8.3%). The incidence was 1.98% in our population. We confirmed that severe cases (very early diagnosed and delivered) were associated with a higher number of prenatal visits and higher uterine arteries (UtA) pulsatility index (PI) centile in the third trimester—TT (compared with the early diagnosed and delivered). In the very early suspected IUGR subgroup, the newborns required significantly more NICU days and total hospitalization days. Conclusions: patients with isolated very early and early IUGR—defined as ultrasound (US) estimation of fetal weight < p10 using the Hadlock 4 technique requiring iatrogenic delivery before 32 weeks’ gestation—require closer care prenatally and postnatally. These patients represent an economical burden for the health system, needing significantly longer hospitalization intervals, GA at birth and UtA PI centiles being related to it.
