PERINATAL OUTCOME OF FETAL GROWTH RESTRICTION AND FACTORS ASSOCIATED WITH IT AT ASELLA TEACHING AND REFERRAL HOSPITAL, SOUTH-EAST ETHIOPA
DOI:
https://doi.org/10.69614/ejrh.v17i01.805Keywords:
Intra uterine growth restriction, Fetal growth restriction, small for gestational age, Low birth weight, unfavorable perinatal outcome, umbilical artery Doppler, Early neonatal death, stillbirth, Neonatal ICUAbstract
Background: Fetal growth restriction (FGR) is a disorder of fetal growth and development due to decreased nutrients and oxygen supply to the fetus. It is caused by placental insufficiency during intrauterine life. FGR is associated with a variety of adverse perinatal outcomes. There is scarcity of data on perinatal outcomes of FGR and factors associated with it in the study area.
Methods: Hospital based cross sectional study was conducted in Asella teaching and referral Hospital from February 1, 2022 to September 30, 2022. A total of 172 study participant were enrolled. Data was entered into epidata version 4.6 and exported to SPSS version 26 for data cleaning & analysis. Logistic regression was done to look for factors associated with unfavorable perinatal outcome. The result was presented using 95% confidence interval of crude and adjusted odds ratios. P-value < 0.05 was used to declare statistical significance.
Result: There were a total of 172 FGR deliveries during the study period. Of these deliveries 107(62.2%) cases have unfavorable perinatal outcome. The odds of having unfavorable perinatal outcome were decreased by 90.2% among mothers 20-34 years (AOR; 0.098, 95% CI: 0.016-0.58). Mother with pre pregnancy BMI between 18.5 -24.9kg/m2 has associated with decreased odds of developing unfavorable perinatal outcome by 80% (AOR; 0.20., 95% CI: 0.07-0.55). Stage 1 FGR and stage 2 FGR were associated with 9.1 times and 22.6 times increased odds of developing unfavorable perinatal outcome when compared with stage 0 FGR (AOR; 9.07, 95% CI: 2.83-29.10) and (AOR; 22.66, 95%CI: 1.84-278.55) respectively. Mother who has no known risk factor for FGR has decreased odds of developing unfavorable perinatal outcome by 79% (AOR; 0.21, 95%CI: 0.049-0.91) while mother who has any form of hypertension has 5.8 times increased odds of developing unfavorable perinatal outcome (AOR; 5.83, 95% CI: 1.14-29.7).
Conclusions and Recommendation: Maternal age, pre pregnancy BMI, stage of FGR, known maternal risk factor for FGR, and presence of maternal hypertension were significantly associated with unfavorable perinatal outcome. We recommended counseling women on nutrition so as to increase their pre-pregnacy BMI before getting pregnant and to intervene for minimizing risk of FGR development in the community.
References
1. Fetal Growth Restriction: ACOG Practice Bulletin, Number 227. Obstet Gynecol. 2021 Feb 1;137(2):e16-e28. doi: 10.1097/AOG.0000000000004251. PMID: 33481528.
2. Lees C.C, Romero R, Stampalija T et al. Clinical Opinion: The diagnosis and management of suspected fetal growth restriction: an evidence-based approach. Am J Obstet Gynecol. 2022 March; 226(3): 366–378. doi:10.1016/j.ajog.2021.11.1357
3. American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics and the Society for Maternal-Fetal Medicin. ACOG Practice Bulletin No. 204: Fetal Growth Restriction. Obstet Gynecol. 2019 Feb;133(2):e97-e109. doi:10.1097/AOG.0000000000003070. PMID: 30681542.
4. Sainky A, Nayar S, Sharma N et al. Perinatal Outcomes of Fetal Growth Restriction, Classified According to the Delphi Consensus Definition: A Prospective Observational Study. J. Fetal Med. (December 2022) 9:113–119 https://doi.org/10.1007/s40556-022-00346-6
5. Tolu LB, Ararso R, Abdulkadir A, Feyissa GT, Worku Y (2020) Perinatal outcome of growth restricted fetuses with abnormal umbilical artery Doppler waveforms compared to growth restricted fetuses with normal umbilical artery Doppler waveforms at a tertiary referral hospital in urban Ethiopia. PLoS ONE 15(6): e0234810. https://doi.org/10.1371/journal.pone.0234810
6. Melamed N, Baschat A, Yinon Yet al. FIGO (International Federation of Gynecology and Obstetrics) initiative on fetal growth: Best practice advice for screening, diagnosis, and management of fetal growth restriction. Int J Gynecol Obstet. 2021;152(Suppl.1):3–57. wileyonlinelibrary.com/journal/ijgo. DOI: 10.1002/ijgo.13522
7. Thekkedathu VCA. Maternal and Placental Risk Factors associated with Intrauterine Growth Restriction and the Perinatal Outcomes. J South Asian Feder Obst Gynae 2015;7(3):176-181
8. Baschat AA and Galan HL. Intrauterine Growth Restriction. In: Steven GG, Jennifer RN, Joe LS et al. Gabbe’s obstetrics essentials: normal and problem pregnancies, 8th edition: Philadelphia, PA: Elsevier, 2019: 563-584.
9. Tesfa D , Tadege M, Digssie A , Abebaw S. Intrauterine growth restriction and its associated factors in South Gondar zone hospitals, Northwest Ethiopia, 2019. Archives of Public Health (2020) 78:89 https://doi.org/10.1186/s13690-020-00475-2
10. Talie A, Taddele M, Alemayehu M. Magnitude of Low Birth Weight and Associated Factors among Newborns Delivered in Dangla Primary Hospital,Amhara Regional State, Northwest Ethiopia. Journal of Pregnancy.Volume 2019, Article ID 3587239 https://doi.org/10.1155/2019/3587239
11. Punyapet P, Suwanrath C , Chainarong N, et al. Predictors of adverse perinatal outcomes in fetal growth restriction using a combination of maternal clinical factors and simple ultrasound parameters. International Journal of Gynecology and Obstetrics;2023 https://doi.org/10.1002/ijgo.14721
12. Zantow EW, Powe JE, Mullan SJ. Prediction of perinatal demise and severe adverse neonatal outcomes in pregnancies with Fetal Growth Restriction. AJOG 2021:513-14
13. Khillan S, Kaur S. Colour Doppler and Adverse Perinatal Outcomes in Pregnancies with Foetal Growth Restriction:A Prospective Longitudinal Study. Journal of Clinical and Diagnostic Research. 2023 Feb, Vol-17(2): DOI: 10.7860/JCDR/2023/58611.17520
14. Rizzo G, Mappa I, Bitsadze V, et al. Role of Doppler ultrasound at time of diagnosis of late-onset fetal growth restriction in predicting adverse perinatal outcome: prospective cohort study. Ultrasound Obstet Gynecol. 2020 Jun;55(6):793-798. doi: 10.1002/uog.20406. Epub 2020 May 8. PMID: 31343783.
15. O'Dwyer V, Burke G, Unterscheider J, et al. Defining the residual risk of adverse perinatal outcome in growth-restricted fetuses with normal umbilical artery blood flow. Am J Obstet Gynecol. 2014 Oct; 211(4):420.e1-5. doi: 10.1016/j.ajog.2014.07.033. Epub 2014 Jul 25. PMID: 25068564.
16. Lubrano C, Taricco E, Coco C. Perinatal and Neonatal Outcomes in Fetal Growth Restriction and Small for Gestational Age. J. Clin. Med. 2022, 11, 729. https://doi.org/10.3390/jcm11102729
17. Lewandowska, M. Maternal Obesity and Risk of Low Birth Weight, Fetal Growth Restriction, and Macrosomia: Multiple Analyses. Nutrients 2021, 13,1213. https://doi.org/10.3390/nu13041213
18. Getaneh T, Asres A, Hiyaru T, Lake S. Adverse perinatal outcomes and its associated factors among adult and advanced maternal age pregnancy in Northwest Ethiopia. Scientific Reports (2021) 11:14072 https://doi.org/10.1038/s41598-021-93613-x
19. Shivaprasad B. Sharma D. To compare the perinatal outcome of IUGR infants with abnormal and normal antenatal umbilical artery Doppler flow in the immediate neonatal period. Int J Reprod Contracept Obstet Gynecol. 2017Apr;6(4):1449-1454
