Prognostic factors and perinatal outcomes in early-onset intrauterine growth restriction due to placental insufficiency

Abstract

Objective

To determine the principal prognostic factors and neonatal outcomes associated with perinatal death in cases of early-onset intrauterine growth restriction (IUGR) due to placental insufficiency and to define the cutoff point for the risk of perinatal death.

Methods

A retrospective cohort study conducted with 198 pregnant women with a diagnosis of early-onset IUGR (as detected before the 32nd week of gestational age). The association between the dependent variable (perinatal death) and the independent variables was investigated using a multivariate logistic regression model. The area under the receiver operating characteristic (ROC) curve was calculated to determine the sensitivity and specificity of the adjusted model. A significance level of 5% was established for the entire statistical analysis.

Results

Perinatal deaths occurred in 89 (44.9%) of the 198 fetuses with early-onset IUGR. Birthweight <800 grams (OR: 14.73; 95%CI: 4.13–52.54; p < .001), postnatal need for mechanical ventilation (OR: 24.56; 95%CI: 5.58–108.08; p < .001) and postnatal use of an oxygen hood (OR: 0.09; 95%CI: 0.02–0.39; p = .001) remained significantly associated with neonatal death in the multivariate model. The sensitivity, specificity, positive and negative predictive values for birthweight <800 grams and need for mechanical ventilation as predictors of death were, respectively, 84%, 91%, 88%, 88% and 93%, 71%, 60% and 96%, while the values for use of an oxygen hood were, respectively, 15%, 62%, 15% and 62%.

Conclusion

The principal determinants of perinatal death in fetuses with early-onset IUGR were birthweight <800 grams, gestational age at delivery <30 weeks and postnatal need for mechanical ventilation as risk factors while postnatal use of an oxygen hood was found to constitute a protective factor.

Keywords:

• Fetal growth retardation placental insufficiency Doppler ultrasonography
• umbilical artery pregnancy outcome

Acknowledgements

The authors are grateful to the invaluable assistance of Professor José Natal Figueiroa in the statistical analysis.

Disclosure of interest

No potential conflict of interest was reported by the author(s).

Authors’ contributions

MWSG and SLDLF performed the data collection. ASRS and SLDLF designed, planned and carried out the study, and wrote this paper. ASRS performed the data analysis. ASRS, GVQLG and SLDLF revised the final text. All the authors approved the final version of this manuscript.

Additional information

Funding

The Institutional Undergraduate Research Grant Program (PIBIC) of the Pernambuco Foundation for the Support of Science and Technology (FACEPE) – BIC-1292-4.01/17.