Umbilical‑artery‑based Doppler versus multimodal surveillance for fetal growth restriction secondary to pre‑eclampsia: a retrospective cohort study in a low‑resource setting.

OBJECTIVES

To determine whether umbilical-artery-based surveillance endorsed by the Society for Maternal-Fetal Medicine (SMFM) yields perinatal outcomes comparable to those of the multimodal International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) protocol in pregnancies with pre-eclampsia-associated fetal growth restriction (FGR).

STUDY

DESIGN

Retrospective cohort of 123 singleton pregnancies complicated by pre-eclampsia and FGR delivered before 37 weeks at a tertiary hospital (2009-2022). FGR was classified as early (<32 weeks) or late (≥32 weeks). Surveillance was categorized as SMFM when care utilized serial umbilical-artery Doppler, or ISUOG when multimodal Doppler (umbilical and cerebral arteries, ductus venosus) plus cardiotocography guided management. Delivery timing followed the respective guidelines.

MAIN OUTCOME MEASURES: Primary outcome was perinatal mortality; secondary outcomes were gestational age at delivery; birth weight and centile; neonatal-intensive-care unit (NICU) stay.

RESULTS

Early-onset FGR comprised 67 % of cases and accounted for all 39 perinatal deaths. Gestational age at delivery, birth weight and mortality were similar between SMFM and ISUOG surveillance. ISUOG identified more severe FGR but did not improve survival. SMFM-based delivery timing shortened mean NICU stay (14.7 vs 25.7 days) and reduced the likelihood of birth weight < 3rd centile, whereas ISUOG surveillance increased this risk.

CONCLUSIONS

Umbilical-artery-focused SMFM surveillance achieved perinatal outcomes comparable to ISUOG's multimodal protocol but with shorter NICU stays. Perinatal loss was confined to early-onset FGR regardless of strategy. These findings support SMFM guidance in resource-limited settings where advanced Doppler and computerized cardiotocography are unavailable and underscore the need for interventions targeting early placental insufficiency.