Perinatal outcomes of two consecutive strategies for the management of fetal growth restriction: a before–after study

Purpose We aim to compare the perinatal outcomes of two consecutive management strategies for fetal growth restriction
(FGR), with or without the inclusion of additional Doppler parameters.
Methods A quasi-experimental before/after study was conducted in which we compared a composite perinatal outcome,
prematurity rate, and neonatal complications between two management strategies in small fetuses. In the strategy 1 (S1), the
management was based on fetal biometry and umbilical artery Doppler. The second strategy (S2) added the assessment of
uterine and middle cerebral artery Doppler. We also compared outcomes between strategies according to early (≤32 weeks)
and late (>32 weeks) diagnosis subgroups.
Results We included 396 patients, 163 in S1 and 233 in S2. There were no signifcant diferences in the perinatal composite
outcome (p 0.98), prematurity (p 0.19), or in the subgroup analysis. We found a signifcant reduction in respiratory distress
syndrome (RDS) rate with S2 both globally (OR 0.50, p 0.02), and in the early diagnosis subgroup (OR 0.45, p 0.01). In
addition, we observed a signifcant reduction in the incidence of sepsis with S2 both globally (OR 0.30, p 0.04) and in the
early diagnosis subgroup (OR 0.25, p 0.02). We did not observe signifcant diferences in necrotizing enterocolitis (p 0.41)
and intraventricular hemorrhage (p 1.00).
Conclusion The expanded strategy for the management of FGR did not show signifcant diferences in the primary composite
outcome or prematurity. However, it was associated with a lower incidence of RDS and neonatal sepsis.