Abstract

Introduction: In 2020 the Center for Disease Control published that infant mortality rates in the united states was 5.4 deaths per 1,000 live deaths. Fetal growth restriction (FGR), previously intra-uterine growth restriction, is associated with increased perinatal mortality and morbidity. Although FGR is typically diagnosed via an ultrasound estimated fetal weight of less than the 10th percentile, this diagnosis alone is not adequately predictive of neonatal risks and outcomes. Various markers associated with FGR have been investigated for their predictive value but have limited data to support their use when considering treatment plans and interventions. However, the relationship between observed-to-expected interval fetal growth and neonatal outcome in FGR pregnancies eludes us. Our study aims to identify if an association exists and fill this gap in knowledge. 

Hypothesis: In women with fetal growth restriction (FGR) the observed to expected interval fetal growth (O/E) is predictive of method of delivery and patient outcome.

Methods: A retrospective cohort study based on chart reviews of patients who presented with pregnancies affected by FGR. Child bearing patient demographics, comorbidities affecting the course of pregnancy, method of delivery and patient outcomes were collected during the chart reviewal process. Pregnancies affected by FGR were assessed for the primary outcome of cesarean delivery and secondary outcomes related to maternal and infant mortality and morbidity, such as NICU/ICU admissions, meconium stained fluid, infant intubation, low APGAR scores, and others. Inclusion criteria were comprised of pregnancies exhibiting FGR that fall below the 10th percentile, singleton, cephalic, with no contraindication to vaginal birth. Exclusion criteria were comprised of multifetal gestations, women with more than 1 prior cesarean, placenta previa, placenta accreta, PPROM, chorioamnionitis, fetal anomalies, and chromosomal abnormalities. Statistical adjustments will be made for confounding factors such as maternal and neonatal comorbidities, smoking status, neonatal anomalies, gestational age at delivery, preeclampsia, maternal HTN, maternal age, medical co-morbidities, and smoking status.

Results: This is an ongoing project encompassing over 900 potential patient participants. The data set is under revision and the study is currently in the data collecting stage.

Conclusion: Due to the expansive nature of this project the chart review process is still ongoing. Therefore, no conclusions can be made at this time because no analysis has been conducted.