Perinatal Outcomes in fetuses with early-onset fetal growth restriction at Chris Hani Baragwanath Academic Hospital (CHBAH) and accuracy of Doppler findings in predicting outcomes
Background: Intrauterine growth restriction (IUGR) is a pregnancy-related complication that is diagnosed more frequently due to improved antenatal surveillance with greater access to ultrasound equipment and training in ultrasound and it affects 3-5% of all pregnancies. The addition of Doppler surveillance in high risk pregnancies has been found to decrease morbidity and mortality by 29%. Methods: This was a prospective cross-sectional descriptive study that took place at Chris Hani Baragwaneth Academic Hospital (CHBAH), a tertiary hospital in Soweto, Johannesburg, which conducts an average of 23,000 deliveries a year. Study participants were collected over a 15 month period and early-onset IUGR was defined as an abdominal circumference of less than the 5th percentile for a given gestation and diagnosed between 26+0 and 32+0 weeks of gestation. Multivessel Doppler surveillance was performed to monitor these fetuses and optimally time delivery. Pregnancy and neonatal outcomes were followed up. Results: A total of 60 women were included in the study. Detailed data on outcomes was available for 47 study participants. Nineteen babies (40.6%) were discharged home after an average hospital stay of 62.6 days and 52.6% of these babies fulfilled the criteria for major morbidity. Twenty eight babies (59.4%) were mortalities, with 9 intrauterine fetal deaths, 2 medical terminations of pregnancy for maternal indications, 3 fresh still births, 9 early neonatal deaths, 3 late neonatal deaths and 2 infant deaths. The average birth weight of babies that survived was 969g and the gestation was 29 weeks and 2 days, while in the group that demised, the average birth weight was 775.8g and the mean gestation was 28weeks and 4 days. All study participants had abnormalities on Doppler studies, with 38 of the 48 study participants having abnormalities in more than one vessel. Abnormalities in the Ductus Venosus, as well as a low birth weight, were shown to be independent risk factors for perinatal mortality. Conclusion Babies born with IUGR at CHBAH tend to have severe, early onset IUGR at the time of diagnosis, with many compounding factors affecting their outcomes, the most important of which is their birth weight and the presence of an abnormal Ductus Venosus Doppler.
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of the Master of Medicine in Obstetrics and Gynaecology. MMed (O&G) Johannesburg, December 2016.
Doppler, High Risk Preganancy