Predictors of perinatal outcome in early‐onset fetal growth restriction: A study from an emerging economy country

What's already known about this topic? The use of fetal arterial and venous Doppler studies is well acknowledged in the context of fetal growth restriction, with ductus venosus evaluation as the most correlated with fetal acidosis and impending risk of death. What does this study add? In a subpopulation of severely growth‐restricted fetuses, the use of z‐score instead of gestational age or fetal weight alone may perform better in a prediction model including biometric and Doppler variables. Objective To identify antenatal predictors of adverse perinatal outcomes in a population of preterm fetuses with early placental insufficiency diagnosed by Doppler abnormalities. Method In this cross‐sectional study of a cohort of singleton pregnant women diagnosed with early placental insufficiency, relationships between perinatal variables (arterial and venous Doppler, gestational age, birth weight, oligohydramnios, estimated fetal weight, and fetal weight z‐scores) and major neonatal complications were analyzed by logistic regression. Results Two hundred sixty‐five women were delivered, between 24 and 33 weeks gestation. The overall frequency of intact survival was 57.9% (n = 154). Gestational age thresholds for best prediction of survival was 27 + 6 weeks and for intact survival was 29 + 0 weeks gestation. Fetal weight and absent/reversed ductus venosus a‐wave were the main predictors of survival in the regression model. When fetal weight was substituted for fetal weight z‐score, ductus venosus abnormal Doppler predicted mortality and absent or reversed umbilical artery diastolic velocities predicted intact survival. Conclusions This study illustrates the impact of gestational age and fetal weight on perinatal outcomes in early placental insufficiency, with well‐defined thresholds. Gestational age and fetal weight, or a combination of fetal weight z‐scores and fetal Doppler parameters, were the best predictors of intact survival in our sample.