How To Manage Intrauterine Growth Restriction Associated With Severe Preeclampsia At 28-34 Weeks Of Gestation?

Aim: To propose optimal management of intrauterine growth restriction (IUGR) cases associated with severe preeclampsia at 28-34 weeks of gestation.
Methods: Two hundred pregnant women with severe preeclampsia associated with growth restricted fetuses were followed with doppler velocimetry of umbilical artery between 28-34 weeks of pregnancy. Patients were grouped according to indications for termination of pregnancy, first group consisted of severely affected doppler velocity waveforms (n:100) and the second group consisted of those whose cardiotocography and biophysic profile were unfavorable (n:100). Groups were compared according to perinatal outcomes (cesarean rates, gestational age at delivery, birth weight, Apgar scores and demand for intubation and perinatal deaths).
Results: The diagnosis to delivery interval is significantly higher in the second group (p<0.05), whereas there was no significant difference between groups regarding gestational age at delivery and parity (p>0.05). Apgar scores were lower in the first group (p<0.05), and there was increased demand for intubation. Perinatal deaths were also lower in the second group (p<0.05). Cesarean rate was significantly lower compared with first group (p<0.05).
Conclusion: Assessment of doppler velocimetry alone may not be enough at decision for termination of pregnancy, biophysic profile and cardiotocography should be added to confirm exact time for delivery of a premature fetus and to improve perinatal outcomes.

Keywords
Severe Preeclampsia, Intrauterine Growth Restriction, Doppler Velocimetry, Biophysic Profile, Perinatal Outcomes