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Clinical Obstetrics

Poster Session 4

(1068) Pregnancy Outcomes in Severe Early-Onset Fetal Growth Restriction: Results from the Multicenter PERIMETER Study

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Severe, early-onset fetal growth restriction (EO-FGR) represents a particularly challenging obstetric cohort. There remains a paucity of data to address optimal timing of delivery, balancing the risk of fetal demise with the potential benefits of advancing gestation. This analysis describes pregnancy outcomes for all cases at one center of EO-FGR due to uteroplacental causes to assist in perinatal counseling.

Study Design: The PERIMETER Study collected all singleton cases of EO-FGR confirmed by ultrasound between 180 and 276wks, at the three largest tertiary referral obstetric hospitals in one city from July 2016 to June 2020. FGR diagnosis was confirmed using electronically-stored ultrasound data, with international Delphi consensus criteria used for diagnosis, including biometry and Doppler data. Cases were considered to be uteroplacental in the absence of structural or genetic abnormality or infection, and in the presence of umbilical artery (UA) Doppler abnormality.

Results: Severe EO-FGR was diagnosed in 250 cases, with uteroplacental cause identified in 154 (62%). Pregnancy outcomes were confirmed for 111 cases, including livebirth (99, 89%) and stillbirth (12, 11%). Liveborn cases were diagnosed later compared with stillbirth (mean (SD) 24.6 (2.4) v 22.2 (1.8) wks, p< 0.001). Liveborn infants < 34wks were more likely to be delivered for abnormal CTG or deteriorating Doppler parameters, and more likely to have UA AEDF or REDF and/or oligo- or anhydramnios pre-delivery, compared with those born later (Table). All but one liveborn infant < 34wks was delivered by cesarean (39/40, 98%), including 4 by classical CS. Amongst stillbirths (n=12), median gestation at confirmed fetal demise was 24.9wks (range 22.3-30.9), including 8 (67%) cases with EFW < 400g. Almost one third of patients required delivery in the maternal interest.

Conclusion: Almost 50% of severe EO-FGR cases deliver < 34wks, with no cases resulting in stillbirth thereafter. Most stillbirths occurred at previable weight. These data will be useful for counseling patients regarding the timing of delivery of EO-FGR pregnancies.