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- Title
Fetal hemodynamics and adverse outcome in primary school-aged children with fetal growth restriction: a prospective longitudinal study.
- Authors
Korkalainen, Noora; Räsänen, Juha; Kaukola, Tuula; Kallankari, Hanna; Hallman, Mikko; Mäkikallio, Kaarin
- Abstract
<bold>Introduction: </bold>Fetal growth restriction is associated with short-term and long-term mortality and morbidity. We hypothesized that adverse outcome in children with fetal growth restriction at primary school age is associated with fetoplacental circulatory abnormalities.<bold>Material and Methods: </bold>Comprehensive ultrasonographic assessment of fetoplacental hemodynamics was performed in 72 growth-restricted fetuses prenatally, and short-term outcome data were collected. At the median age of 9 years, mortality and morbidity were determined using medical charts and questionnaires. The impact of abnormal fetoplacental hemodynamics on mortality and morbidity with significant developmental disorders or delay were studied.<bold>Results: </bold>Fetal growth restriction children with adverse long-term outcome were delivered earlier and with lower birthweights than were those with non-compromised outcome. Seventy percent of the fetal growth restriction group showed non-compromised long-term outcomes and participated in mainstream education at the appropriate age level. Absent/retrograde diastolic flow in the umbilical artery (p < 0.001), negative A-wave in the ductus venosus (p = 0.006), cardiomegaly (p = 0.02), hydrops (p = 0.006) and cardiovascular profile score <6 (p = 0.002) were associated with increased risk of adverse outcome. After adjustment for gestational age, these parameters demonstrated hazard ratios of 5.0-16.5 for adverse long-term outcome; increased systemic venous pulsatility and low cardiovascular profile score had the highest predictive power.<bold>Conclusions: </bold>Absent or reversed end-diastolic flow in the umbilical artery, reversed A-wave in the ductus venosus, cardiomegaly, hydrops, and low cardiovascular profile score are associated with adverse outcomes at primary school age in fetal growth restriction children. These fetal parameters play a significant role in the prediction of long-term outcomes for fetal growth restriction children.
- Subjects
FINLAND; HEMODYNAMICS; INFANT diseases; FETAL development; ULTRASONIC imaging; HEART dilatation; BLOOD circulation; APGAR score; BIRTH weight; DEVELOPMENTAL disabilities; DIASTOLE (Cardiac cycle); FETAL growth retardation; CARDIAC hypertrophy; PREMATURE infants; LONGITUDINAL method; PHYSICS; UMBILICAL arteries; UMBILICAL veins; FETAL heart rate; HYDROPS fetalis; PHYSIOLOGY
- Publication
Acta Obstetricia et Gynecologica Scandinavica, 2017, Vol 96, Issue 1, p69
- ISSN
0001-6349
- Publication type
journal article
- DOI
10.1111/aogs.13052