Moderate to late preterm intrauterine growth restriction: A restrospective, observational study of the indications for delivery and outcomes in an Australian perinatal centre

Bridie Stewart, Amalia Karahalios, Rosalynn Pszczola, Joanne Said

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: The management of preterm intrauterine growth restriction is limited to fetal surveillance and timely delivery. Despite the existence of evidence-based guidelines, uncertainty regarding the optimal timing of delivery is common, and management remains individualised for each patient. Aims: To provide recent Australian data on the indications for delivery of moderate to late preterm growth restricted infants and the outcomes of these deliveries. Materials and methods: Retrospective study of singleton live births delivered between 32 + 0 and 36 + 6 weeks gestation over a three-year period (2012–2014) at a Melbourne Metropolitan Hospital. ‘Small for gestational age’ (birthweight < 10th centile for gestation) identified intrauterine growth restricted infants. Indications for iatrogenic delivery were broadly categorised into maternal, fetal or pregnancy related. Obstetric and neonatal outcome variables were compared to other preterm infants using logistic regression. Results: Of the 146 (18.6%) small for gestational age infants born during the study period, 103 were iatrogenic deliveries, most commonly due to fetal indications (53.4%). Small for gestational age infants had higher odds of hypoglycaemia (adjusted odds ratio = 1.87, 95% CI: 1.23–2.84, P = 0.003) and jaundice (1.52, 1.01–2.28, P = 0.043) than their appropriately grown counterparts; however, there was no increase in the risk of serious morbidity or mortality. Conclusions: In this cohort, iatrogenic preterm delivery of small for gestational age infants between 32 + 0 and 36 + 6 weeks gestation was most commonly due to fetal indications and did not increase the risk of serious, short-term neonatal outcomes compared to their appropriately grown counterparts.

Original languageEnglish
Pages (from-to)306-314
Number of pages9
JournalAustralian and New Zealand Journal of Obstetrics and Gynaecology
Volume58
Issue number3
DOIs
Publication statusPublished - 1 Jun 2018
Externally publishedYes

Keywords

  • fetal growth restriction
  • perinatal death
  • premature birth
  • premature infant
  • small for gestational age infant

Cite this

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title = "Moderate to late preterm intrauterine growth restriction: A restrospective, observational study of the indications for delivery and outcomes in an Australian perinatal centre",
abstract = "Background: The management of preterm intrauterine growth restriction is limited to fetal surveillance and timely delivery. Despite the existence of evidence-based guidelines, uncertainty regarding the optimal timing of delivery is common, and management remains individualised for each patient. Aims: To provide recent Australian data on the indications for delivery of moderate to late preterm growth restricted infants and the outcomes of these deliveries. Materials and methods: Retrospective study of singleton live births delivered between 32 + 0 and 36 + 6 weeks gestation over a three-year period (2012–2014) at a Melbourne Metropolitan Hospital. ‘Small for gestational age’ (birthweight < 10th centile for gestation) identified intrauterine growth restricted infants. Indications for iatrogenic delivery were broadly categorised into maternal, fetal or pregnancy related. Obstetric and neonatal outcome variables were compared to other preterm infants using logistic regression. Results: Of the 146 (18.6{\%}) small for gestational age infants born during the study period, 103 were iatrogenic deliveries, most commonly due to fetal indications (53.4{\%}). Small for gestational age infants had higher odds of hypoglycaemia (adjusted odds ratio = 1.87, 95{\%} CI: 1.23–2.84, P = 0.003) and jaundice (1.52, 1.01–2.28, P = 0.043) than their appropriately grown counterparts; however, there was no increase in the risk of serious morbidity or mortality. Conclusions: In this cohort, iatrogenic preterm delivery of small for gestational age infants between 32 + 0 and 36 + 6 weeks gestation was most commonly due to fetal indications and did not increase the risk of serious, short-term neonatal outcomes compared to their appropriately grown counterparts.",
keywords = "fetal growth restriction, perinatal death, premature birth, premature infant, small for gestational age infant",
author = "Bridie Stewart and Amalia Karahalios and Rosalynn Pszczola and Joanne Said",
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Moderate to late preterm intrauterine growth restriction : A restrospective, observational study of the indications for delivery and outcomes in an Australian perinatal centre. / Stewart, Bridie; Karahalios, Amalia; Pszczola, Rosalynn; Said, Joanne.

In: Australian and New Zealand Journal of Obstetrics and Gynaecology, Vol. 58, No. 3, 01.06.2018, p. 306-314.

Research output: Contribution to journalArticleResearchpeer-review

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T2 - A restrospective, observational study of the indications for delivery and outcomes in an Australian perinatal centre

AU - Stewart, Bridie

AU - Karahalios, Amalia

AU - Pszczola, Rosalynn

AU - Said, Joanne

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Y1 - 2018/6/1

N2 - Background: The management of preterm intrauterine growth restriction is limited to fetal surveillance and timely delivery. Despite the existence of evidence-based guidelines, uncertainty regarding the optimal timing of delivery is common, and management remains individualised for each patient. Aims: To provide recent Australian data on the indications for delivery of moderate to late preterm growth restricted infants and the outcomes of these deliveries. Materials and methods: Retrospective study of singleton live births delivered between 32 + 0 and 36 + 6 weeks gestation over a three-year period (2012–2014) at a Melbourne Metropolitan Hospital. ‘Small for gestational age’ (birthweight < 10th centile for gestation) identified intrauterine growth restricted infants. Indications for iatrogenic delivery were broadly categorised into maternal, fetal or pregnancy related. Obstetric and neonatal outcome variables were compared to other preterm infants using logistic regression. Results: Of the 146 (18.6%) small for gestational age infants born during the study period, 103 were iatrogenic deliveries, most commonly due to fetal indications (53.4%). Small for gestational age infants had higher odds of hypoglycaemia (adjusted odds ratio = 1.87, 95% CI: 1.23–2.84, P = 0.003) and jaundice (1.52, 1.01–2.28, P = 0.043) than their appropriately grown counterparts; however, there was no increase in the risk of serious morbidity or mortality. Conclusions: In this cohort, iatrogenic preterm delivery of small for gestational age infants between 32 + 0 and 36 + 6 weeks gestation was most commonly due to fetal indications and did not increase the risk of serious, short-term neonatal outcomes compared to their appropriately grown counterparts.

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