[Year:2022] [Month:September-December] [Volume:13] [Number:3] [Pages:10] [Pages No:101 - 110]
Objective of the study: To identify adverse perinatal outcomes, these include stillbirth, neonatal death, hypoxic-ischemic encephalopathy, need for mechanical ventilation, or severe metabolic acidosis in small for gestational age (SGA) and in all stages of fetal growth restriction (FGR) based on Barcelona Protocol.
To evaluate the demographic variables, maternal risk factors, mode of delivery, birthweight, and indications of operative delivery in SGA and all stages of FGR.
Materials and methods: It is a prospective observational study underwent from January 2019 to June 2019 at the Department of Fetal Medicine, Fernandez Hospital. All mothers with singleton pregnancies, who came for fetal growth scan, it’s mandatory to have expected delivery date (EDD) confirmed in first trimester itself and estimated fetal weight (EFW) < 10th percentile were included in the study.
Multiple pregnancies, structurally abnormal fetuses, first scan >20 weeks (GA not accurate) were excluded from the study.
Mothers with EFW < 10th percentile underwent serial sonographic evaluation of estimated fetal weight at 2-weekly intervals including multivessel Doppler assessment based on staged-based protocol. If the EFW 3–10th percentile, multivessel Doppler findings are within normal range the fetus is termed as SGA fetus and is followed up every 2 weeks. If the EFW < 3rd percentile or any of the multivessel Doppler findings show features of placental insufficiency, the fetus is termed as FGR, and management is based on the stage-based Barcelona Protocol. Maternal, fetal, and neonatal characteristics, neonatal morbidity, and adverse perinatal outcome were recorded.
Results: Among 6,240 mothers who underwent growth scans during the study period, 14% (n = 858) with EFW < 10th percentile were taken as the study population. A total of 768 pregnant women were included in the study. Based on Barcelona protocol, 68% (n = 521) and 32% (n = 247) were termed FGR and SGA, respectively. FGR fetuses were classified into four stages —488 (95%), 23(14.4%), 10(2%), I, II, III, and IV, respectively.
Among 247 pregnant women with SGA fetuses, 42% required induction of labor, FGR stage I (488), 40% required induction of labor. FGR stage II & III fetuses (25) 27% required induction of labor.
Fetuses grouped under stages II & III have 61% admissions into NICU, compared to 12% in FGR stage I and 2% SGA group fetuses.
There are no adverse perinatal outcomes in SGA group.
In FGR stage I group, adverse perinatal outcomes in terms of metabolic acidosis, 5 minutes APGAR < 7, hypoxic ischemic encephalopathy (HIE), need for mechanical ventilation are 1.8%, 0.6%, 0.6%, 0.8%, respectively.
In FGR stage II & III, metabolic acidosis was diagnosed in five (15%) neonates, two neonates (6%) required mechanical ventilation with four (12%) of stillbirths. There is one neonatal death (NND) in the entire cohort, classified under FGR stage I.
Conclusion: Incorporation of Barcelona protocol as a structured antenatal surveillance protocol discriminates between SGA fetuses and stages of FGR. Prenatal recognition of FGR allows for close monitoring and timely delivery. There is a higher risk for adverse perinatal outcomes in FGR II & III compared to FGR stage I and SGA fetuses.