The Impact of Fetal Growth Restriction

on Latency in the Setting of Expectant

Management of Preeclampsia
David McKinney, Heather Boyd, Amanda Langager, Michael
Oswald, Abbey Pfister, Carri R, Warshak
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Background

Preeclampsia & fetal growth restriction

common complications of pregnancy.
Preeclampsia complicates 6-8% of all
pregnancies.
preeclampsia with pregnancies
complicated by advanced maternal age,
obesity, & multiple gestation.

Background
Preeclampsia

Background
Pregnancy complicated by preeclampsia
relative risk of stilbirth :
6-8 fold higher at 26 weeks
7 fold higher at 34 weekss gestation
Delivery is the only known definitive management
of preeclampsia : patient have early onset
preeclampsia risk of expectant management
must be balanced with the risk of preterm delivery.

Background
Patient < 34 weeks gestation with preeclampsia

Background

FGR fetus with estimated fetal weight <

10th precentile for gestational age.
FGR occur in 10% of all pregnancies
Hypertension in pregnancy (preeclampsia)
risk of FGR

Background

Bakcground
Preeclampsia

Background

Absent or reversed end diastolic flow in

umbilical artery risk of perinatal
mortality alteration in Doppler
measurements often affect delivery
planning.

Objective

To assess the impact FGR has on the

latency period during expectant
management of all preeclampsia patients
diagnosed prior to 34 weeks.

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Materials and Methods

Retrospective cohort study of all patients

who delivered between January 2008
January 2013 at University of Cincinnati
Medical Center.
Approved by local institutional review
board.
Performed prior to the American College of
Obstetricians and Gynecologists Task Force
on Hypertension in Pregnancy Guidelines
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Material and Methods

Diagnosis :

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Material and Methods

Diagnosis prior to 34 weeks expectant

management is more aggresively pursued.
Only included patients who had a
management plan that explicitly stated
expectant management.

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Material and Methods

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Material and Methods

Treatment Patients with suspected preeclampsia

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Material and Methods

Primary outcome

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Material and Methods

Secondary outcome :

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Material and Methods

Multivariate logistic regression to estimate crude odds ratio and adjuste

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Material and Methods

Study data collected and managed

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Results

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Results

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Results

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Results

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Results

Maternal demographics (age, race, tobacco use, history of chronic hype

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Results

No differences in presence of severe disease, major complications, or n

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Results

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Results

In the presence of FGR, delivery more likely for non-reassuring fetal sta

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Results
GRF had significantly :

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Results

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Results

Post hoc logistic regression analysis con

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Comment

In this study latency period from

diagnosis to delivery in women with
concurrent preeclampsia <34 weeks and
FGR is significantly shorter than in women
with preeclampsia in normally grown
fetuses.
When FGR present, median interval
delivery was only 3 days & 79,3% patients
were delivered within 7 days.
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Comment

Antenatal corticosteroid maximum benefit

when given 1-7 days prior to birth.
Concomitant FGR no delay in administration.
More pronounced underlying placental
dysfunction/insufficiency when preeclampsia
complicated by FGR.
Initial analysis they also had lower birth
weights, higher percentage of SGA infants,
higher NICU admission, longer stay in NICU.
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Comment

Chammas et al,2000

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Comment

24 hour observation
period, magnesium,
betamethasone,
monitoring fetal heart rate
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Comment

Chammas et al

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Comment

Result in study by Chammas et al very similar to the findings in our stu

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Comment
Strength of this study

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Comment

Limitations:

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Comment

These result more accurately &

effectively counsel families regarding
expectations for delaying delivery,
betamethasone administration & maternal
support when indicated.

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