The course of pregnancy and childbirth outcomes in different fetal growth restriction phenotypes


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Abstract

Objective: To investigate the clinical value of a phenotypic approach for the analysis of perinatal outcomes in fetal growth restriction (FGR). Materials and methods: This retrospective analysis included 230 pregnancy cards and delivery notes. The patients were divided into Group I including 200/230 (87%) pregnant women with adverse FGR outcome; Group II consisted of30/230 (13%) pregnant women with uncomplicated pregnancy and normal fetal growth trajectory. The phenotypic approach consisted of classifying FGR cases according to maternal, placental, and fetal risk factors for this pathology and then analyzing the contribution of each phenotype to the probability of an adverse fetal outcome. Results: In step 1, all analyzed observations were divided into 7 clinical FGR phenotypes. In step 2, the FGR clinical phenotypes were divided into three risk groups according to adverse perinatal outcomes: high, intermediate and low risk of perinatal loss. High-risk according to the study results corresponds to the FGR clinical phenotypes "preterm delivery" (59.6%), "infections" (45.1%), "hypertensive disorders during pregnancy" (37.3%), and "bleeding in the second and third trimesters" (24.8%). The intermediate risk was "chronic maternal disease" (9.9%), "no baseline risk factors" (11.4%), and the lowest risk model included the remaining clinical phenotypes. Among stillborns with FGR (n=64), the following FGR phenotypes were observed: "infections" (34.4%), "preterm delivery" (20.3%), "hypertensive disorders during pregnancy" (14.1%), and "bleeding in the second and third trimesters" (14.1%). Early neonatal mortality was highest in the clinical phenotypes "preterm delivery" (39.3%) and "hypertensive disorders during pregnancy" (23.2%). Conclusion: Seven clinical phenotypes of FGR associated with different risk of adverse perinatal outcomes were analyzed. The highest risk of stillbirth was noted in FGR concurrent with severe prematurity (the "premature delivery" phenotype), infectious affection of the fetal placental unit (the "infection" phenotype), and in II- III trimester hemorrhages caused by placental abruption, recurrent retrochorial hematomas, and placental abnormalities.

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About the authors

Diana I. Yakubova

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: diana_28_03_94@mail.ru
Post-Graduate Student, Department of Obstetrics, Gynecology and Perinatology of Institute of Clinical Medicine

Irina V. Ignatko

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: ignatko_i_v@staff.sechenov.ru
Corresponding Member of RAS, Dr. Med. Sci., Professor at the Department of Obstetrics, Gynaecology and Perinatology of Institute of Clinical Medicine

Aren D. Megrabyan

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: arentek@mail.ru
Post-Graduate Student, Department of Obstetrics, Gynecology and Perinatology of Institute of Clinical Medicine

Irina M. Bogomazova

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: bogomazova_i_m@staff.sechenov.ru
PhD, Associate Professor, Department of Obstetrics, Gynecology and Perinatology of Institute of Clinical Medicine

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