The pre-eclampsia, growth restriction, and ductus venosus doppler (GRADED) study: An observational study of early-onset fetal growth restriction and pre-eclampsia.

OBJECTIVE

To assess the feasibility of using ductus venosus Doppler (DVD) to time delivery in early-onset fetal growth restriction (FGR) and pre-eclampsia in a resource-constrained setting.

METHODS

This was a prospective, observational study of pregnancies affected by early-onset FGR and pre-eclampsia. Patient characteristics, risk factors, ultrasound findings, and pregnancy outcomes were entered into a data collection tool. The association of these variables with perinatal and maternal outcomes were determined using binary logistic regression analysis.

RESULTS

The study had 61 participants. Most patients were delivered at 29-31+6 weeks of pregnancy (67%). Neonates with an estimated fetal weight on ultrasound of less than 800 g had the highest incidence of perinatal mortality (63%). There was a near six-fold increase in risk of major neonatal morbidity in patients with abnormal DVD (odds ratio 5.9, 95% confidence interval [CI] 1.8-19.0). Absent flow in the DVD a-wave carried a higher risk of perinatal mortality (OR 23.8, 95% CI 1.7-334.8); 22% of patients with an abnormal DVD a-wave experienced placental abruption.

CONCLUSION

Having an abnormal DVD in the background of pre-eclampsia was related to increased perinatal morbidity and mortality, with increased risk of placental abruption.