Determination of the ideal timing of delivery among growth- restricted fetuses at less than 32 weeks age of gestation using a stage-based doppler protocol for admitted patients at the Philippine Children&rsquo;s Medical Center

Ma. Theresa   A. Muldong,; Maria Estrella    Y. Flores,

Determination of the ideal timing of delivery among growth- restricted fetuses at less than 32 weeks age of gestation using a stage-based doppler protocol for admitted patients at the Philippine Children’s Medical Center

Ma. Theresa A. Muldong | Maria Estrella Y. Flores

Abstract:

OBJECTIVES: Early onset fetal growth restriction substantially contributes to neonatal morbidities and mortalities. The main dilemma lies on the timing of delivery, especially for pre- and peri-viable fetuses, due to the challenge in creating an ideal balance of minimized in-utero hypoxia-induced fetal injury or death versus the risks of iatrogenic preterm delivery. We wished to determine the ideal timing of delivery among growth-restricted fetuses <32 weeks gestation using a stage-based doppler protocol. MATERIALS AND METHODS: A retrospective-cohort study of 67 singleton-pregnant women with growth restriction at <32 weeks gestation and hospitalized from January 2010 to September 2021 was conducted. Medical records were reviewed, and the outcomes were extracted. The primary outcomes were arterial pH at birth and mortality, while secondary outcomes included neonatal morbidities. RESULTS: Fetal growth restriction progressed by an average of 3 stages (41.79%) within a 2- to 3.5-week period. More than half had arterial pH <7.20, which was lowest at Stage II FGR (50.00%). The prevalence of neonatal mortality was 16.42% and was lowest at Stage I (8.70%) and Stage II FGR (18.75%). CONCLUSION: Doppler studies may be conducted weekly for Stage I, biweekly for Stage II, every 1-2 days for Stage III and every 12 hours for Stage IV. Delivery

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