Evaluation of the results of fetuses diagnosed with intrauterine growth restriction

Objective: Intrauterine growth retardation(IUGR) is one of the main challenges of prenatal care due to the increase in neonatal morbidity and mortality with preterm labor it brought. The aim is to timely identify the fetuses with the highest risk of in utero death and neonatal morbidity that can benefit from preterm labor and to plan the delivery time well with appropriate management. Material and Method: Our study is a retrospective study. This study evaluated demographic characteristics and perinatal outcomes of 452 patients who were followed-up with the diagnosis of IUGR in the Perinatology Division of the Department of Gynecology and Obstetrics of Çukurova University's Faculty of Medicine between 01 January 2015 and 01 January 2019. All singleton pregnancies with suspected IUGR were included in the study. 334(73.9%) patients without congenital anomaly, type of growth retardation, gestational week, estimated fetal weight (EFW), delivery week, presence of preeclampsia, doppler findings relationship with birth weight, delivery week, 5th minute Apgar score, neonatal intensive care need and newborn negative results were reviewed. Results: Congenital anomaly was detected in 118(26.1%) patients, and no congenital anomaly was detected in 334(73.9%) patients. The average age of patients without anomaly was 29.6 ± 6.4 (min-max: 17-45). The mean IUGR diagnosis gestational week was 30.9 ± 4.5 (min-max: 18-39). The mean week of delivery of the patients was 34.4 ± 4.5 (min-max: 22-41). Smoking was present in 41(12.7%) of the patients, while 283(87.3%) did not smoke. Patients were examined in groups as <27 + 6, 28-31, 32-36, >37 according to the week of gestation they were diagnosed with. Asymmetric IUGR was observed in 113(33.8%) patients and symmetrical IUGR was observed in 221(66.2%). In the group without anomaly, preeclampsia did not occur in 273(81.7%) of the patients, while 61(18.3%) of the patients had preeclampsia. Doppler findings were normal in 141 (43.1%) patients and impaired in 193(56.9%) patients. When comparing preeclampsia patients with those without preeclampsia for doppler disorder, although abnormal findings such as placental bleeding and chronic decollement detects statistically significant difference (p <0.05), the results between those with and without preeclampsia were similar, and the statistical difference was not significant considering the 5th minute Apgar score, stillbirth, neonatal intensive care requirement. Our data reveal that the severity of doppler findings worsens the perinatal outcomes. Again, our study shows that having EFW <3pc affects the perinatal results of infants negatively. Conclusions: In the study, we found that preterm delivery was significantly higher in pregnancies with IUGR and simultaneous preeclampsia. However, in the group with and without preeclampsia at 35 weeks of gestation, the perinatal results were similar and the results were positive in both groups. Considering these data, we can say that late-onset preeclampsia does not negatively affect the perinatal outcomes of infants, but prematurity significantly contributes to neonatal morbidity and mortality due to preterm delivery in early-onset preeclampsia. The study suggests that delaying delivery in the presence of uncertainties in a very early growth-restricted fetus results in some stillbirths, but unexpected delivery results in an almost equal number of neonatal deaths, and neither approach results in improved long-term neurodevelopmental outcomes. Considering that total mortality is only in 5(2.8%) and morbidity is only in 2(1.0%) infants over 35 weeks of gestation in our study, we think it is beneficial to postpone delivery until the 37th week of gestation unless fetal well-being allows and there are no other indications for premature birth. In the light of the data, our study is a current study which examines the records in a tertiary hospital, provides new contributions to the literature, and guides researchers for further research.