Optimizing the definition of intrauterine growth restriction: the multicenter prospective PORTO Study
Objective The objective of the Prospective Observational Trial to Optimize Pediatric Health in Intrauterine Growth Restriction (IUGR) (PORTO Study), a national prospective observational multicenter study, was to evaluate which sonographic findings were associated with perinatal morbidity and mortali...
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| Veröffentlicht in: | American journal of obstetrics and gynecology 2013-04, Vol.208 (4), p.290.e1-290.e6 |
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| creator | Unterscheider, Julia, MD Daly, Sean, MD Geary, Michael Patrick, MD Kennelly, Mairead Mary, MD McAuliffe, Fionnuala Mary, MD O'Donoghue, Keelin, PhD Hunter, Alyson, MD Morrison, John Joseph, MD Burke, Gerard, FRCOG Dicker, Patrick, PhD Tully, Elizabeth Catherine, PhD Malone, Fergal Desmond, MD |
| description | Objective The objective of the Prospective Observational Trial to Optimize Pediatric Health in Intrauterine Growth Restriction (IUGR) (PORTO Study), a national prospective observational multicenter study, was to evaluate which sonographic findings were associated with perinatal morbidity and mortality in pregnancies affected by growth restriction, originally defined as estimated fetal weight (EFW) |
| doi_str_mv | 10.1016/j.ajog.2013.02.007 |
| format | Article |
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Study Design Over 1100 consecutive ultrasound-dated singleton pregnancies with EFW <10th centile were recruited from January 2010 through June 2012. A range of IUGR definitions were used, including EFW or abdominal circumference <10th, <5th, or <3rd centiles, with or without oligohydramnios and with or without abnormal umbilical arterial Doppler (pulsatility index >95th centile, absent or reversed end-diastolic flow). Adverse perinatal outcome, defined as a composite outcome of intraventricular hemorrhage, periventricular leukomalacia, hypoxic ischemic encephalopathy, necrotizing enterocolitis, bronchopulmonary dysplasia, sepsis, and death was documented for all cases. Results Of 1116 fetuses, 312 (28%) were admitted to neonatal intensive care unit and 58 (5.2%) were affected by adverse perinatal outcome including 8 mortalities (0.7%). The presence of abnormal umbilical Doppler was significantly associated with adverse outcome, irrespective of EFW or abdominal circumference measurement. The only sonographic weight-related definition consistently associated with adverse outcome was EFW <3rd centile ( P = .0131); all mortalities had EFW <3rd centile. Presence of oligohydramnios was clinically important when combined with EFW <3rd centile ( P = .0066). Conclusion Abnormal umbilical artery Doppler and EFW <3rd centile were strongly and most consistently associated with adverse perinatal outcome. Our data call into question the current definitions of IUGR used. Future studies may address whether using stricter IUGR cutoffs comparing various definitions and management strategies has implications on resource allocation and pregnancy outcome.]]></description><identifier>ISSN: 0002-9378</identifier><identifier>EISSN: 1097-6868</identifier><identifier>DOI: 10.1016/j.ajog.2013.02.007</identifier><identifier>PMID: 23531326</identifier><language>eng</language><publisher>United States: Mosby, Inc</publisher><subject>Adult ; definition ; Female ; Fetal Growth Retardation - diagnostic imaging ; Fetal Growth Retardation - epidemiology ; Fetal Weight ; Humans ; Infant, Newborn ; intrauterine growth restriction ; Obstetrics and Gynecology ; perinatal morbidity and mortality ; Perinatal Mortality ; Pregnancy ; Pregnancy Outcome ; Prospective Studies ; small for gestational age ; Ultrasonography</subject><ispartof>American journal of obstetrics and gynecology, 2013-04, Vol.208 (4), p.290.e1-290.e6</ispartof><rights>Mosby, Inc.</rights><rights>2013 Mosby, Inc.</rights><rights>Copyright © 2013 Mosby, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c477t-b059843023171735040bfabedb4c86be818af83d2a4c9cc9e45c044ea8e3295e3</citedby><cites>FETCH-LOGICAL-c477t-b059843023171735040bfabedb4c86be818af83d2a4c9cc9e45c044ea8e3295e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002937813001439$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23531326$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Unterscheider, Julia, MD</creatorcontrib><creatorcontrib>Daly, Sean, MD</creatorcontrib><creatorcontrib>Geary, Michael Patrick, MD</creatorcontrib><creatorcontrib>Kennelly, Mairead Mary, MD</creatorcontrib><creatorcontrib>McAuliffe, Fionnuala Mary, MD</creatorcontrib><creatorcontrib>O'Donoghue, Keelin, PhD</creatorcontrib><creatorcontrib>Hunter, Alyson, MD</creatorcontrib><creatorcontrib>Morrison, John Joseph, MD</creatorcontrib><creatorcontrib>Burke, Gerard, FRCOG</creatorcontrib><creatorcontrib>Dicker, Patrick, PhD</creatorcontrib><creatorcontrib>Tully, Elizabeth Catherine, PhD</creatorcontrib><creatorcontrib>Malone, Fergal Desmond, MD</creatorcontrib><title>Optimizing the definition of intrauterine growth restriction: the multicenter prospective PORTO Study</title><title>American journal of obstetrics and gynecology</title><addtitle>Am J Obstet Gynecol</addtitle><description><![CDATA[Objective The objective of the Prospective Observational Trial to Optimize Pediatric Health in Intrauterine Growth Restriction (IUGR) (PORTO Study), a national prospective observational multicenter study, was to evaluate which sonographic findings were associated with perinatal morbidity and mortality in pregnancies affected by growth restriction, originally defined as estimated fetal weight (EFW) <10th centile. Study Design Over 1100 consecutive ultrasound-dated singleton pregnancies with EFW <10th centile were recruited from January 2010 through June 2012. A range of IUGR definitions were used, including EFW or abdominal circumference <10th, <5th, or <3rd centiles, with or without oligohydramnios and with or without abnormal umbilical arterial Doppler (pulsatility index >95th centile, absent or reversed end-diastolic flow). Adverse perinatal outcome, defined as a composite outcome of intraventricular hemorrhage, periventricular leukomalacia, hypoxic ischemic encephalopathy, necrotizing enterocolitis, bronchopulmonary dysplasia, sepsis, and death was documented for all cases. Results Of 1116 fetuses, 312 (28%) were admitted to neonatal intensive care unit and 58 (5.2%) were affected by adverse perinatal outcome including 8 mortalities (0.7%). The presence of abnormal umbilical Doppler was significantly associated with adverse outcome, irrespective of EFW or abdominal circumference measurement. The only sonographic weight-related definition consistently associated with adverse outcome was EFW <3rd centile ( P = .0131); all mortalities had EFW <3rd centile. Presence of oligohydramnios was clinically important when combined with EFW <3rd centile ( P = .0066). Conclusion Abnormal umbilical artery Doppler and EFW <3rd centile were strongly and most consistently associated with adverse perinatal outcome. Our data call into question the current definitions of IUGR used. Future studies may address whether using stricter IUGR cutoffs comparing various definitions and management strategies has implications on resource allocation and pregnancy outcome.]]></description><subject>Adult</subject><subject>definition</subject><subject>Female</subject><subject>Fetal Growth Retardation - diagnostic imaging</subject><subject>Fetal Growth Retardation - epidemiology</subject><subject>Fetal Weight</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>intrauterine growth restriction</subject><subject>Obstetrics and Gynecology</subject><subject>perinatal morbidity and mortality</subject><subject>Perinatal Mortality</subject><subject>Pregnancy</subject><subject>Pregnancy Outcome</subject><subject>Prospective Studies</subject><subject>small for gestational age</subject><subject>Ultrasonography</subject><issn>0002-9378</issn><issn>1097-6868</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1u1DAUhS0EosPAC7BAWbJJuP5J4iCEVFXQIlUaRMvacpybqUPiDLZTNDw9DlNYsGBlWT7n-tzvEPKSQkGBVm-GQg_zvmBAeQGsAKgfkQ2Fps4rWcnHZAMALG94Lc_IsxCG9coa9pScMV5yylm1Ibg7RDvZn9bts3iHWYe9dTba2WVzn1kXvV4ieusw2_v5R7zLPIborVklb39bpmWM1qBLsuzg53DA9HiP2efdl9tddhOX7vicPOn1GPDFw7klXz9-uL24yq93l58uzq9zI-o65i2UjRQcGKc1rXkJAtpet9i1wsiqRUml7iXvmBamMaZBURoQArVEzpoS-Za8Ps1NOb4vKaiabDA4jtrhvASVdqacyzr9sCXsJDUpcvDYq4O3k_ZHRUGteNWgVrxqxauAqYQ3mV49zF_aCbu_lj88k-DdSYBpy3uLXgVj0RnsrE9YVDfb_89__4_djKkOo8dveMQwzIt3iZ-iKiSDulkbXfulHIAK3vBfgaWh6w</recordid><startdate>20130401</startdate><enddate>20130401</enddate><creator>Unterscheider, Julia, MD</creator><creator>Daly, Sean, MD</creator><creator>Geary, Michael Patrick, MD</creator><creator>Kennelly, Mairead Mary, MD</creator><creator>McAuliffe, Fionnuala Mary, MD</creator><creator>O'Donoghue, Keelin, PhD</creator><creator>Hunter, Alyson, MD</creator><creator>Morrison, John Joseph, MD</creator><creator>Burke, Gerard, FRCOG</creator><creator>Dicker, Patrick, PhD</creator><creator>Tully, Elizabeth Catherine, PhD</creator><creator>Malone, Fergal Desmond, MD</creator><general>Mosby, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20130401</creationdate><title>Optimizing the definition of intrauterine growth restriction: the multicenter prospective PORTO Study</title><author>Unterscheider, Julia, MD ; Daly, Sean, MD ; Geary, Michael Patrick, MD ; Kennelly, Mairead Mary, MD ; McAuliffe, Fionnuala Mary, MD ; O'Donoghue, Keelin, PhD ; Hunter, Alyson, MD ; Morrison, John Joseph, MD ; Burke, Gerard, FRCOG ; Dicker, Patrick, PhD ; Tully, Elizabeth Catherine, PhD ; Malone, Fergal Desmond, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c477t-b059843023171735040bfabedb4c86be818af83d2a4c9cc9e45c044ea8e3295e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>definition</topic><topic>Female</topic><topic>Fetal Growth Retardation - diagnostic imaging</topic><topic>Fetal Growth Retardation - epidemiology</topic><topic>Fetal Weight</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>intrauterine growth restriction</topic><topic>Obstetrics and Gynecology</topic><topic>perinatal morbidity and mortality</topic><topic>Perinatal Mortality</topic><topic>Pregnancy</topic><topic>Pregnancy Outcome</topic><topic>Prospective Studies</topic><topic>small for gestational age</topic><topic>Ultrasonography</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Unterscheider, Julia, MD</creatorcontrib><creatorcontrib>Daly, Sean, MD</creatorcontrib><creatorcontrib>Geary, Michael Patrick, MD</creatorcontrib><creatorcontrib>Kennelly, Mairead Mary, MD</creatorcontrib><creatorcontrib>McAuliffe, Fionnuala Mary, MD</creatorcontrib><creatorcontrib>O'Donoghue, Keelin, PhD</creatorcontrib><creatorcontrib>Hunter, Alyson, MD</creatorcontrib><creatorcontrib>Morrison, John Joseph, MD</creatorcontrib><creatorcontrib>Burke, Gerard, FRCOG</creatorcontrib><creatorcontrib>Dicker, Patrick, PhD</creatorcontrib><creatorcontrib>Tully, Elizabeth Catherine, PhD</creatorcontrib><creatorcontrib>Malone, Fergal Desmond, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of obstetrics and gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Unterscheider, Julia, MD</au><au>Daly, Sean, MD</au><au>Geary, Michael Patrick, MD</au><au>Kennelly, Mairead Mary, MD</au><au>McAuliffe, Fionnuala Mary, MD</au><au>O'Donoghue, Keelin, PhD</au><au>Hunter, Alyson, MD</au><au>Morrison, John Joseph, MD</au><au>Burke, Gerard, FRCOG</au><au>Dicker, Patrick, PhD</au><au>Tully, Elizabeth Catherine, PhD</au><au>Malone, Fergal Desmond, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Optimizing the definition of intrauterine growth restriction: the multicenter prospective PORTO Study</atitle><jtitle>American journal of obstetrics and gynecology</jtitle><addtitle>Am J Obstet Gynecol</addtitle><date>2013-04-01</date><risdate>2013</risdate><volume>208</volume><issue>4</issue><spage>290.e1</spage><epage>290.e6</epage><pages>290.e1-290.e6</pages><issn>0002-9378</issn><eissn>1097-6868</eissn><abstract><![CDATA[Objective The objective of the Prospective Observational Trial to Optimize Pediatric Health in Intrauterine Growth Restriction (IUGR) (PORTO Study), a national prospective observational multicenter study, was to evaluate which sonographic findings were associated with perinatal morbidity and mortality in pregnancies affected by growth restriction, originally defined as estimated fetal weight (EFW) <10th centile. Study Design Over 1100 consecutive ultrasound-dated singleton pregnancies with EFW <10th centile were recruited from January 2010 through June 2012. A range of IUGR definitions were used, including EFW or abdominal circumference <10th, <5th, or <3rd centiles, with or without oligohydramnios and with or without abnormal umbilical arterial Doppler (pulsatility index >95th centile, absent or reversed end-diastolic flow). Adverse perinatal outcome, defined as a composite outcome of intraventricular hemorrhage, periventricular leukomalacia, hypoxic ischemic encephalopathy, necrotizing enterocolitis, bronchopulmonary dysplasia, sepsis, and death was documented for all cases. Results Of 1116 fetuses, 312 (28%) were admitted to neonatal intensive care unit and 58 (5.2%) were affected by adverse perinatal outcome including 8 mortalities (0.7%). The presence of abnormal umbilical Doppler was significantly associated with adverse outcome, irrespective of EFW or abdominal circumference measurement. The only sonographic weight-related definition consistently associated with adverse outcome was EFW <3rd centile ( P = .0131); all mortalities had EFW <3rd centile. Presence of oligohydramnios was clinically important when combined with EFW <3rd centile ( P = .0066). Conclusion Abnormal umbilical artery Doppler and EFW <3rd centile were strongly and most consistently associated with adverse perinatal outcome. Our data call into question the current definitions of IUGR used. Future studies may address whether using stricter IUGR cutoffs comparing various definitions and management strategies has implications on resource allocation and pregnancy outcome.]]></abstract><cop>United States</cop><pub>Mosby, Inc</pub><pmid>23531326</pmid><doi>10.1016/j.ajog.2013.02.007</doi></addata></record> |
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| subjects | Adult definition Female Fetal Growth Retardation - diagnostic imaging Fetal Growth Retardation - epidemiology Fetal Weight Humans Infant, Newborn intrauterine growth restriction Obstetrics and Gynecology perinatal morbidity and mortality Perinatal Mortality Pregnancy Pregnancy Outcome Prospective Studies small for gestational age Ultrasonography |
| title | Optimizing the definition of intrauterine growth restriction: the multicenter prospective PORTO Study |
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