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Open Access Research article

Fetal growth restriction and the risk of perinatal mortality–case studies from the multicentre PORTO study

Julia Unterscheider1*, Keelin O’Donoghue2, Sean Daly3, Michael P Geary4, Mairead M Kennelly5, Fionnuala M McAuliffe6, Alyson Hunter7, John J Morrison8, Gerard Burke9, Patrick Dicker10, Elizabeth C Tully1 and Fergal D Malone1

Author Affiliations

1 Obstetrics & Gynaecology, Royal College of Surgeons in Ireland, Dublin, Ireland

2 Obstetrics & Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland

3 Obstetrics & Gynaecology, Coombe Women and Infants University Hospital, Dublin, Ireland

4 Obstetrics & Gynaecology, Rotunda Hospital, Dublin, Ireland

5 UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland

6 Obstetrics & Gynaecology, UCD School of Medicine and Medical Science, National Maternity Hospital, Dublin, Ireland

7 Obstetrics & Gynaecology, Royal Jubilee Maternity Hospital, Belfast, Ireland

8 Obstetrics & Gynaecology, National University of Ireland, Galway, Ireland

9 Obstetrics & Gynaecology, Graduate Entry Medical School, University of Limerick, Limerick, Ireland

10 Epidemiology & Public Health, Royal College of Surgeons in Ireland, Dublin, Ireland

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BMC Pregnancy and Childbirth 2014, 14:63  doi:10.1186/1471-2393-14-63

Published: 11 February 2014

Abstract

Background

Intrauterine growth restriction (IUGR) is the single largest contributing factor to perinatal mortality in non-anomalous fetuses. Advances in antenatal and neonatal critical care have resulted in a reduction in neonatal deaths over the past decades, while stillbirth rates have remained unchanged. Antenatal detection rates of fetal growth failure are low, and these pregnancies carry a high risk of perinatal death.

Methods

The Prospective Observational Trial to Optimize Paediatric Health in IUGR (PORTO) Study recruited 1,200 ultrasound-dated singleton IUGR pregnancies, defined as EFW <10th centile, between 24+0 and 36+6 weeks gestation. All recruited fetuses underwent serial sonographic assessment of fetal weight and multi-vessel Doppler studies until birth. Perinatal outcomes were recorded for all pregnancies. Case records of the perinatal deaths from this prospectively recruited IUGR cohort were reviewed, their pregnancy details and outcome were analysed descriptively and compared to the entire cohort.

Results

Of 1,116 non-anomalous singleton infants with EFW <10th centile, 6 resulted in perinatal deaths including 3 stillbirths and 3 early neonatal deaths. Perinatal deaths occurred between 24+6 and 35+0 weeks gestation corresponding to birthweights ranging from 460 to 2260 grams. Perinatal deaths occurred more commonly in pregnancies with severe growth restriction (EFW <3rd centile) and associated abnormal Doppler findings resulting in earlier gestational ages at delivery and lower birthweights. All of the described pregnancies were complicated by either significant maternal comorbidities, e.g. hypertension, systemic lupus erythematosus (SLE) or diabetes, or poor obstetric histories, e.g. prior perinatal death, mid-trimester or recurrent pregnancy loss. Five of the 6 mortalities occurred in women of non-Irish ethnic backgrounds. All perinatal deaths showed abnormalities on placental histopathological evaluation.

Conclusions

The PNMR in this cohort of prenatally identified IUGR cases was 5.4/1,000 and compares favourably to the overall national rate of 4.1/1,000 births, which can be attributed to increased surveillance and timely delivery. Despite antenatal recognition of IUGR and associated maternal risk factors, not all perinatal deaths can be prevented.

Keywords:
Perinatal mortality; Antepartum stillbirth; Neonatal death; Intrauterine growth restriction; PORTO Study