دورية أكاديمية
Doppler ultrasound of umbilical and middle cerebral artery in third trimester small-for-gestational age fetuses to decide on timing of delivery for suspected fetal growth restriction: A cohort with nested RCT (DRIGITAT).
| العنوان: | Doppler ultrasound of umbilical and middle cerebral artery in third trimester small-for-gestational age fetuses to decide on timing of delivery for suspected fetal growth restriction: A cohort with nested RCT (DRIGITAT). |
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| المؤلفون: | Marijnen MC; Department of Obstetrics and Gynaecology, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands.; Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands., Kamphof HD; Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands., Damhuis SE; Department of Obstetrics and Gynaecology, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands.; Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands.; Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands., Smies M; Department of Obstetrics and Gynaecology, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands.; Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands., Leemhuis AG; Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands., Wolf H; Department of Obstetrics and Gynaecology, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands., Gordijn SJ; Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands., Ganzevoort W; Department of Obstetrics and Gynaecology, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands.; Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands. |
| مؤلفون مشاركون: | DRIGITAT Trial Group |
| المصدر: | BJOG : an international journal of obstetrics and gynaecology [BJOG] 2024 Jul; Vol. 131 (8), pp. 1042-1053. Date of Electronic Publication: 2024 Feb 05. |
| نوع المنشور: | Journal Article; Multicenter Study; Randomized Controlled Trial |
| اللغة: | English |
| بيانات الدورية: | Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 100935741 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1471-0528 (Electronic) Linking ISSN: 14700328 NLM ISO Abbreviation: BJOG Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Original Publication: Oxford [England] : Blackwell Science, [2000]- |
| مواضيع طبية MeSH: | Fetal Growth Retardation*/diagnostic imaging , Infant, Small for Gestational Age* , Umbilical Arteries*/diagnostic imaging , Pregnancy Trimester, Third* , Middle Cerebral Artery*/diagnostic imaging , Ultrasonography, Prenatal* , Ultrasonography, Doppler*, Humans ; Female ; Pregnancy ; Adult ; Infant, Newborn ; Delivery, Obstetric/methods ; Pregnancy Outcome ; Cohort Studies ; Gestational Age |
| مستخلص: | Objective: To assess the association of the umbilicocerebral ratio (UCR) with adverse perinatal outcome in late preterm small-for-gestational age (SGA) fetuses and to investigate the effect on perinatal outcomes of immediate delivery. Design: Multicentre cohort study with nested randomised controlled trial (RCT). Setting: Nineteen secondary and tertiary care centres. Population: Singleton SGA pregnancies (estimated fetal weight [EFW] or fetal abdominal circumference [FAC] <10th centile) from 32 to 36 +6 weeks. Methods: Women were classified: (1) RCT-eligible: abnormal UCR twice consecutive and EFW below the 3 rd centile at/or below 35 weeks or below the 10 th centile at 36 weeks; (2) abnormal UCR once or intermittent; (3) never abnormal UCR. Consenting RCT-eligible patients were randomised for immediate delivery from 34 weeks or expectant management until 37 weeks. Main Outcome Measures: A composite adverse perinatal outcome (CAPO), defined as perinatal death, birth asphyxia or major neonatal morbidity. Results: The cohort consisted of 690 women. The study was halted prematurely for low RCT-inclusion rates (n = 40). In the RCT-eligible group, gestational age at delivery, birthweight and birthweight multiple of the median (MoM) (0.66, 95% confidence interval [CI] 0.59-0.72) were significantly lower and the CAPO (n = 50, 44%, p < 0.05) was more frequent. Among patients randomised for immediate delivery there was a near-significant lower birthweight (p = 0.05) and higher CAPO (p = 0.07). EFW MoM, pre-eclampsia, gestational hypertension and Doppler classification were independently associated with the CAPO (area under the curve 0.71, 95% CI 0.67-0.76). Conclusions: Perinatal risk was effectively identified by low EFW MoM and UCR. Early delivery of SGA fetuses with an abnormal UCR at 34-36 weeks should only be performed in the context of clinical trials. (© 2024 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.) |
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| معلومات مُعتمدة: | Roche Diagnostics; 843002825 Netherlands ZONMW_ ZonMw |
| فهرسة مساهمة: | Investigator: JM Schaaf; MA de Boer; JJ Zwart; AJM Huisjes; JHW Veerbeek; JOEH van Laar; S Al-Nasiry; HA Bremer; BBJ Hermsen; HP van de Nieuwenhof; M Sueters; DP van der Ham; MS Post; JA Kroese; JB Derks; JM Sikkema; JW de Leeuw Keywords: Doppler velocimetry; cerebroplacental ratio; fetal growth restriction; placental insufficiency; small for gestational age; umbilicocerebral ratio |
| تواريخ الأحداث: | Date Created: 20240318 Date Completed: 20240603 Latest Revision: 20240603 |
| رمز التحديث: | 20240603 |
| DOI: | 10.1111/1471-0528.17770 |
| PMID: | 38498267 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1471-0528 |
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| DOI: | 10.1111/1471-0528.17770 |