PREDICTORS OF PERINATAL OUTCOME IN INTRAUTERINE GROWTH-RETARDATION - A LONG-TERM STUDY

Fifty-three intrauterine retarded fetuses (IUGR) and seventy-five healthy pregnancies were monitored by neurobehavioural profile (quiet state or S1F and activity state or S2F percentages) and umbilical artery Doppler velocimetry (UA RI) on two occasions between the 27th-32nd and the 33rd-36th week of gestation. The aims of the present study were the following 1) to relate S1F, S2F and RI to mild and severe IUGR 2) to relate behavioural state analysis and UA Doppler velocimetry to the following perinatal outcomes: Cesarean section (CS); Preterm delivery (PD); small for gestational age (SGA); Apgar score at 1st and 5th min < 7; Respiratory Distress Syndrome (RDS); Neurological Injury (NI) (evaluated at the birth, the 4th, the 8th and the 12th month of life). 3) to establish the best predictors of perinatal outcome with these monitoring parameters by a stepwise computerized processing. Our results suggest: 1) mild IUGR, characterized by a progressive increase in peripheral vascular resistances, positive diastolic peak flow (RI: 0.72 +/- 0.01; mean +/- SD), is associated with gradual increase in S1F (12.51 +/- 2.84; mean +/- SD) and a decrease in S2F (27.51 +/- 2.81; mean +/- SD) percentages; 2) severe IUGR, characterized by zero or negative diastolic peak flow (UA RI --> 1), is associated with a significant increase in S1F (21.32 +/- 12.11; mean +/- SD) and a decrese in S2F percentages (30.93 +/- 20.35; mean +/- SD). In conclusion: S1F is the best predictor of severe IUGR and significant for all the perinatal outcomes selected; S2F is the best predictor of mild IUGR and significant for SGA; UA RI is the best parameter for recognizing mild IUGR and evolution to severe IUGR.