The brain is probably the most complex system of the human body, composed of numerous neural units interconnected at dierent scales. This highly structured architecture provides the ability to communicate, synthesize information and perform the analytical tasks of human beings. Its development starts during the transition between the embryonic and fetal periods, from a simple tubular to a highly complex folded structure. It is globally organized as early as birth. This developing process is highly vulnerable to antenatal adverse conditions. Indeed, extreme prematurity and intra uterine growth restriction are major risk factors for long-term morbidities, including developmental ailments such as cerebral palsy, mental retardation and a wide spectrum of learning disabilities and behavior disorders. In this context, the characterization of the brainâ s normative wiring pattern is crucial for our understanding of its architecture and workings, as the origin of many neurological and neurobehavioral disorders is found in early structural brain development. Diusion magnetic resonance imaging (dMRI) allows the in vivo assessment of biological tissues at the microstructural level. It has emerged as a powerful tool to study brain connectivity and analyse the underlying substrate of the human brain, comprising its structurally integrated and functionally specialized architecture. dMRI has been widely used in adult studies. Nevertheless, due to technical constraints, this mapping at earlier stages of development has not yet been accomplished. Yet, this time period is of extreme importance to comprehend the structural and functional integrity of the brain. This thesis is motivated by this shortfall, and intends to fill the gap between the clinical and neuroscience demands and the methodological developments needed to fulfill them. In our work, we comprehensibly study the brain structural connectivity of children born extremely prematurely and/or with additional prenatal restriction at school-age. We provide evidence that brain systems that mature early in development are the most vulnerable to antenatal insults. Interestingly, the alterations highlighted in these systems correlate with the neurobehavioral and cognitive impairments seen in these children at school-age. The overall brain organization appear also altered after preterm birth and prenatal restriction. Indeed, these children show dierent brain network modular topology, with a reduction in the overall network capacity. What remains unclear is whether the alterations seen at school age are already present at birth and, if yes, to what extent. In this thesis we set the technical basis to enable the connectome analysis as early as at birth. This task is challenging when dealing with neonatal data. Indeed, most of the assumptions used in adult data processing methods do not hold, due to the inverted image contrast and other MRI artefacts such as motion, partial volume and intensity inhomogeneities. Here, we propose a novel technique for surface reconstruction, and provide a fully-automatic procedure to delineate the newborn cortical surface, opening the way to establish the newborn connectome.
98Intrauterine growth restriction is associated with persistent aortic wall thickening and glomerular proteinuria during infancy
Intrauterine growth restriction is associated with persistent aortic wall thickening and glomerular proteinuria during infancy
Read more82Association of Chlamydia trachomatis and Mycoplasma hominis with intrauterine growth retardation and preterm delivery. The John Hopkins Study of Cervicitis and Adverse Pregnancy Outcome.
The authors conducted a prospective study of risk factors for intrauterine growth retardation (birth weight less than a standard (race- and sex-adjusted) 10th percentile for gestational age) and preterm birth (birth prior to 37 weeks gestation) in a high-risk, inner-city, obstetric population, with special interest in pathogens colonizing the maternal genital tract. A total of 801 women within 22 to 30 weeks of gestation were enrolled and interviewed. Subjects were cultured for Gardnerella vaginalis, group B streptococcus, Trichomonas vaginalis, Neisseria gonorrhoeae, Bacteroides fragilis, Mycoplasma hominis, Ureaplasma urealyticum, Chlamydia trachomatis, and Candida albicans, and they were followed to delivery. Intrauterine growth retardation and preterm delivery occurred in 8% and 13% of these pregnancies, respectively. After adjustment for other important risk factors, colonization with C. trachomatis was significantly associated both with intrauterine growth retardation (odds ratio = 2.4, 90% confidence interval 1.32-4.18) and preterm delivery (odds ratio = 1.6, 90% confidence interval 1.01-2.50). Colonization with C. albicans was significantly associated with intrauterine growth retardation (odds ratio = 1.9, 90% confidence interval 1.20-3.14); colonization with M. hominis was significantly associated with preterm birth (odds ratio = 2.0, 90% confidence interval 1.42-2.93). These associations support the probable role of infection in preterm and intrauterine growth retardation births and suggest the need for carefully designed intervention studies.
Read more64Fetal Programming of Adult Kidney Disease
The role of the kidney in the pathogenesis of hypertension has long been established, although recent studies challenge renal hegemony and suggest an important role for vascular cells as well (1,2). In recent years, the formulation has expanded and now includes the concept that chronic hypertension and kidney disease are also related to events that occur during the prenatal period and usually result in low birth weight (LBW). A recent overview considered the role of fetal programming in the development of adult kidney disease and hypertension (3). The aim of this review is to present further evidence to support an association between LBW and the increased prevalence of hypertension as well as progression toward chronic kidney disease (CKD) in adult life. Various potential mechanisms for this association are discussed, specifically the low nephron number (LNN) hypothesis and related cellular and molecular mechanisms that have been proposed. LBW infants are defined as infants who weigh ≤2500 g at birth. Infants who are delivered before 37 wk from the first day of the last menstrual period are termed preterm. The LBW infant population can be divided into preterm, appropriate for gestational age (AGA), or small for gestational age (SGA). The predominant cause of LBW infants in the United States is preterm birth, whereas in developing countries, the cause is often intrauterine growth restriction (IUGR). During the year 2004, 8.1% of births in the United States were LBW, and more than half of these were preterm. During the past two decades, there has been an increase in the prevalence of LBW as higher risk pregnancies progress to term and postnatal survival improves (4) (Figure 1). Figure 1. Percentage of infants who were born preterm and percentage who were born with low birth weight (LBW; defined in text): United States, 1990, 1995, 2000, …
Read moreReproductive Outcome in Women with different Types of Congenital Uterine Anomalies
Introduction: Mullerian ducts are the primordial analogue of female genital tract. They differentiate to form the fallopian tubes, uterine body, cervix and upper part of the vagina. A wide variety of malformation occur when this system is disrupted. The range from uterine agenesis, duplication of uterus to minor cavity abnormalities. All these congenital anomalies have been implicated as a potential cause for impaired reproductive outcome. Our aim was to evaluate the association between different types of congenital anomaly and various reproductive outcome. Material & Methods: This cross sectional descriptive study was conducted at the Department of gynae and obstetrics in Dhaka Medical College and Hospital (DMCH), Ad-din Women’s Medical College and Hospital and Gonoshasthaya Samaj Vittik Medical College and Hospital during the period of March 2012 to September 2022.The study subjects were women with uterine anomalies who were diagnosed during evaluation of causes for bad obstetric history, during infertility work up or incidental findings during antenatal investigations or during Carsarian section . Reproductive outcomes were observed in the form of infertility, miscarriage, preterm delivery, ectopic pregnancy, intra uterine growth retardation (IUGR) and post-partum haemorrhage (PPH). These were recorded in a standard research questionnaire. Data were analyzed regarding types of uterine anomalies and their reproductive performance. Results: During the study period total 84 patients were recruited with uterine anomalies. Regarding distributions of uterine anomalies in study subjects the most common uterine anomaly was bicornuate uterus (n-32,38%), followed by arcuate uterus (n-18,21%), septate uterus (n-16,19%), unicornuate uterus (n-12,14%), and uterine didelphys (n-6,7. 1%).Women with bicornuate uterus was associated with miscarriage (37.25%), term delivery (31.25%) and preterm delivery (25%). Therefore, bicornuate uterus was found more evident with miscarriage. Only two cases of ectopic pregnancy were observed in the study which was found with bicornuate uterus. And in arcuate uterus percentage of preterm delivery was 44.4%, term delivery 33.3%, miscarriage only 22.2%. Therefore, arcuate uterus was more associated with preterm delivery. In septate uterus miscarriage was maximum (37.5%) followed byl term and pre term delivery, 12.5% each We found 12 cases of unicornuateuterus, where pregnancy continued to term in 6(50%) cases,2 aborted and 4(33.3)were delivered before term. Infertility was more associated with canalization defect, 6 cases with septate and 2 with didelphys uterus. Among live births (preterm and term deliveries,) malpresentation (breech, transverse) was more common in bicornuate uterus (44%).PPh was found in 2 cases of didelphys and two of bicornuate uterus. One case of septate and one from bicornuate uterus were associated with IUGR. Conclusion: The study makes clear that congenital uterine anomaly is associated with poor reproductive outcome. The exact effect is dependent on the type of anomaly.
Read more2Role of Intervention Strategies for At-risk Preterm Infants
Role of Intervention Strategies for At-risk Preterm Infants
336Low birth weight in the United States
Low birth weight in the United States
Risk factors for extrauterine growth retardation in moderate and late preterm infants
Objective To study the incidence and risk factors for extrauterine growth retardation (EUGR) at discharge in moderate and late preterm infants. Methods A retrospective analysis was performed on 607 premature infants who were admitted to the neonatal intensive care unit between January 1st, 2016 and December 31st, 2016.These subjects were classified into EUGR (n=159) and non-EUGR groups (n=448) based on the body weight at discharge.The risk factors for the occurrence of EUGR were studied by multivariate logistic regression analysis. Results Based on the body weight, the incidence of EUGR at discharge was 26.2%(159/607). The incidence of EUGR in intrauterine growth restriction (IUGR) infants was significantly higher than in non-IUGR infants (P<0.001). The very low birth weight (VLBW) infants had a higher incidence of EUGR than non-VLBW infants (P<0.05). Compared with the non-EUGR group, the fasting time, the age to achieve full enteral feeds, the length of mechanical ventilation, oxygen therapy and the length of hospital stays were significantly greater in the EUGR group (P<0.05). The percentages of caesarean section, multiple gestation, pregnancy-induced hypertension, intrahepatic cholestasis of pregnancy and umbilical cord abnormality in the EUGR group were higher than in the non-EUGR group(P<0.05). The incidences of septicemia, hypoalbuminemia, anemia, retinopathy of prematurity, brain injury in premature infants and mechanical ventilation in the EUGR group were higher than in the non-EUGR group(P<0.05). The logistic regression analysis showed that birth weight, IUGR, multiple gestation, abnormality of umbilical cord and the length of hospital stays were the independent risk factors for EUGR. Conclusion The causes of EUGR are multi-factorial.To strengthen pregnancy care, aggressive and reasonable nutritional strategy, prevention and treatment of complications may facilitate to reduce the occurrence of EUGR. Key words: Premature infant; Extrauterine growth retardation; Intrauterine growth retardation; Retinopathy of prematurity
Read more22Early fetal growth: concepts and pitfalls
Early fetal growth: concepts and pitfalls
Low-to-Moderate Gestational Alcohol Use and Intrauterine Growth Retardation, Low Birthweight, and Preterm Delivery
PURPOSE: Heavy drinking during pregnancy is an established risk factor for fetal alcohol syndrome and other adverse perinatal outcomes. However, there is still debate as to the effects of low-to-moderate drinking during pregnancy. METHODS: This prospective investigation was based on 2714 singleton live births at Yale-New Haven Hospital during 1988–1992. Alcohol drinking during pregnancy was evaluated with respect to intrauterine growth retardation (IUGR), preterm delivery, and low birth weight. RESULTS: Mild drinking, defined as > 0.10 – 0.25 oz of absolute alcohol per day, during the first month of pregnancy was associated with a protective effect on IUGR (OR, 0.39; 95% confidence interval (CI), 0.20 – 0.76). Overall, drinking during month 1 of pregnancy suggested a curvilinear effect on growth retardation, with consumption of > 1.00 oz of absolute alcohol per day showing increased risk. Drinking during month 7 was associated with a uniform increase in the odds of preterm delivery; the ORs were 2.88 (95% CI, 1.64 – 5.05) for light drinking and 2.96 (95% CI, 1.32 – 6.67) for mild-to-moderate alcohol consumption. CONCLUSIONS: Differences in the risk estimates for IUGR and preterm delivery may indicate etiological differences that warrant further investigation of these outcomes and critical periods of exposure. Low birthweight is not a useful neonatal outcome for this exposure because it is a heterogeneous mix of preterm delivery and IUGR. Despite the observed protective effects of mild drinking on IUGR, the increased risk of preterm delivery with alcohol use supports a policy of abstinence during pregnancy.
Read moreHubungan Prematur dengan Cerebral Palsy di Rumah Sakit Al-Islam Bandung
Abstract. Cerebral palsy (CP) is one of the clinically and socially significant non-progressive neurological disorders, often associated with preterm birth. This study aims to evaluate the relationship between preterm birth and the incidence of CP at Al-Islam Hospital Bandung for the period 2022–2024 using a retrospective approach based on medical record data. Among 519 preterm infants, 40 infants (63,5%) were diagnosed with CP, whereas only 23 infants (36,5%) out of 1,631 term infants were affected. The analysis revealed a significant relationship between preterm birth and the incidence of CP (p < 0.001). An Odds Ratio of 5.838 (95% CI: 3.461–9.849) indicated that preterm infants are 5.8 times more likely to develop CP compared to term infants. This study demonstrates that prematurity is a significant risk factor for CP. Preterm infants have a higher prevalence of CP compared to term infants. These findings underscore the importance of preventive interventions, such as optimal prenatal care and improved neonatal facilities, to reduce the risk of CP in preterm infants. Further research is needed to evaluate other factors that may influence the relationship between prematurity and CP. Abstrak. Cerebral palsy (CP) merupakan salah satu gangguan neurologis non-progresif yang signifikan secara klinis dan sosial, sering kali berhubungan dengan kelahiran prematur. Penelitian ini bertujuan untuk mengevaluasi hubungan antara kelahiran prematur dan kejadian CP di Rumah Sakit Al-Islam Bandung periode 2022–2024 dengan pendekatan retrospektif menggunakan data rekam medis. Dari 519 bayi prematur, sebanyak 40 bayi (63,5%) mengalami CP, sedangkan dari 1.631 bayi cukup bulan, hanya 23 bayi (36,5%) yang mengalami CP. Hasil analisis menunjukkan hubungan yang signifikan antara kelahiran prematur dan kejadian CP (p < 0,001). Odds Ratio sebesar 5,838 (95% CI: 3,461–9,849) mengindikasikan bahwa bayi prematur memiliki peluang 5,8 kali lebih besar untuk mengalami CP dibandingkan bayi cukup bulan. Penelitian ini menunjukkan bahwa prematuritas merupakan faktor risiko signifikan untuk CP. Bayi prematur memiliki prevalensi CP yang lebih tinggi dibandingkan bayi cukup bulan. Hasil ini menekankan pentingnya intervensi preventif, seperti perawatan prenatal yang optimal dan peningkatan fasilitas neonatal, untuk mengurangi risiko CP pada bayi prematur. Penelitian lebih lanjut diperlukan untuk mengevaluasi faktor-faktor lain yang dapat memengaruhi hubungan antara prematuritas dan CP.
Read moreA follow-up study of extremely low birth weight infants at four to eleven years of age
Objective To analyze the relationship between the incidence of complications and disease condition during hospitalization in severe preterm infants after birth, and to understand the situation and problems in treatment of these infants through a follow-up study of extremely low birth infants (ELBWIs) at four to eleven years of age. Methods A follow-up study was carried out in all ELBWIs who were born between January 2000 and December 2009 in five hospitals of Beijing area. The study was conducted from May 2011 to August 2013. Clinical data of these ELBWIs were collected. Development of those ELBWIs was measured in the Peking Union Medical College Hospital, including physical, mental and motional development. Their cardiopulmonary functions were also examined. The incidence and treatment of disease in each system was analyzed, especially the incidence of severe complications. Descriptive statistical analysis was performed. Results (1) A total of 48 ELBWIs were followed up, with 24.4 to 34.0 weeks of gestation at birth, averaging (29.1±2.4) weeks. The birth weight of those ELBWIs was 700-900 g, with an average of (895±68) g. Among the 48 ELBWIs, 36 (75.0%) preterm infants were delivered for maternal gestational hypertensive disorders. Thirty-nine cases (81.2%) were small for gestational age. Those ELBWIs at 4.0-10.6 years of age were followed up, with an average age of (5.6±1.8) years. Thirty-six cases (75.0%) were followed up at clinic visits, and the other 12 cases (25.0%) were followed up through telephone calls. (2) Among the 48 cases, 31(64.6%) had lower weight, and 28(58.3%) had lower height than the average level. Fourteen children (29.2%) had physical retardation, among whom, seven cases had lower height, one case had lower weight, and six cases had both lower weight and height by 10 percentile. (3) Among the 48 cases, 42 cases (87.5%) had neonatal respiratory distress syndrome, 11(22.9%) had bronchopulmonary dysplasia, and 3(6.3%) had bronchial asthma. During the follow-up, 28 cases underwent ventilatory function tests. Moderately impaired pulmonary function was found in four cases (14.3%) ,mildly impaired pulmonary function in six cases (21.4%) and the pulmonary function was almost normal in the other 18 cases (64.3%). (4) Among the 48 cases, 10(20.8%) had patent ductus arteriosus, 1(2.1%) had atrioventricular block, and another case (2.1%) had ventricular premature beats and supraventricular tarchycardia. Two cases (5.6%, 2/36) had mildly dilated coronary sinus. (5) Six cases (12.5%) had intracranial hemorrhage of level Ⅲ-Ⅳ, and with no sequelae after treatment. Four cases (8.3%) were diagnosed as cerebral palsy, and one case (2.1%) as epilepsy in early childhood. (6) Mental development assessment was performed in 25 cases. Among them, two cases of cerebral palsy had mild or moderate mental retardation, four cases had border intelligence, and the other 19 cases had normal intelligence. (7) During hospitalization, sepsis occurred in three cases (14.6%), necrotizing enterocolitis in six cases (12.5%), and meningitis in one case (2.1%). All those cases were cured. (8) Among seven cases (14.6%) of retinopathy of prematurity, three cases received laser treatment, the other four cases improved after observation. None of them had visual impairment. One case (2.1%) had hearing impairment during follow-up. (9) Two years after discharge, 13 cases (27.1%) were rehospitalized for one to five times, with an average of (1.0±0.4) times. Eleven of the cases were rehospitalized for respiratory infections, and two cases for hernia or dermal hemangioma, respectively. Conclusions The incidence rate of development retardation in ELBWIs is high in this area. Cerebral palsy may occur in ELBWIs without intracranial hemorrhage. Treatment strategies should be further established to improve the development retardation, reduce severe complications and sequelae, and to improve the quality of life of the children. Key words: Infant, extremely low birth weight; Follow-up studies
Read more20Cerebral Palsy Among Children Born Moderately and Late Preterm
The preterm birth rate has increased markedly in recent decades, mainly because of the increase in late preterm (LP) births. Late preterm infants are those born between 34+0 and 36+6 weeks’ gestation and account for more than 70% of all prematurely born infants in the United States. Moderately preterm (MP) (32+0–33+6 weeks) and LP infants together comprise more than 80% of all preterm births. Late preterm infants may have poor neurodevelopmental outcomes, and one relatively common disorder is cerebral palsy (CP), diagnosed based on medical history, imaging data, and clinical multidisciplinary evaluations. Cerebral palsy incidence also depends on gestational age (GA) in very preterm (VP) infants. Risk factors for CP have been identified for term infants, but not as thoroughly for MP and LP infants. This Finnish national-register study was performed to compare the CP incidence among LP and MP infants to that in VP and term infants and to identify risk factors for CP. The study population included all 1,039,263 infants born in Finland from 1991 to 2008. Data on baseline and pregnancy/infant characteristics, live births, deaths, and congenital anomalies were collected from several national registries. After exclusions, the final cohort included 1,018,302 infants. Infants were followed up to age 7 years or to 2009. Gestational age categories were classified as VP (≤32+0 weeks, n = 6347), MP (32+0–33+6 weeks, n = 6799), LP (34+0–36+6 weeks, n = 39,932), and term (≥37 weeks, n = 965,224). Time periods were 1991 to 1995, 1996 to 2001, and 2002 to 2008. Pregnancy-related risk factors were the number of fetuses and their order, timing of birth, in vitro fertilization, and cervical cerclage. Resuscitation at birth included intubation, mechanical ventilation, or chest compressions. Late preterm and MP infants accounted for 75% and 13%, respectively, of all premature infants born during the study period. The proportion of all preterm births was 5.02% in 1991 to 1995, 5.43% in 1996 to 2001, and 5.18% in 2002 to 2008. Moderately preterm infants accounted for 0.63% to 0.69% and LP infants for 3.82% to 4.08% of all births. Cerebral palsy was diagnosed in 2242 cases. The incidence of CP was 0.22%, and this rate decreased nonlinearly with increasing GA and time. The proportion of diplegia cases was greatest in the VP group and of hemiplegia cases in the term group. Birth during 1991 to 1995, 1-minute Apgar score of less than 7, and intracranial hemorrhage predicted CP in all GA categories in the logistic regression model. Resuscitation at birth was associated with an increased risk in the MP, LP, and term groups. Small for GA and antibiotic treatment during the first hospitalization seemed to predict an increased risk of CP in the LP and the term groups. Premature rupture of membranes was associated with an increased risk and antenatal steroid treatment with a decreased risk of CP in the MP group. In the analysis for 2004 to 2008, the odds ratio for CP in the MP group with antenatal steroids was 0.24 (95% confidence interval [CI], 0.08–0.76). Respiratory distress syndrome predicted a decreased risk of CP in the LP group. Independent odds ratios for CP in premature groups compared with the full-term group were 9.37 in the VP group (95% CI, 7.34–11.96), 5.12 in the MP group (95% CI, 4.13–6.34), and 2.35 in the LP group (95% CI, 1.99–2.77). The incidence and risk for CP were higher in MP and LP infants compared with term infants. The medical expense burden of CP to the families of the MP and LP children was comparable to term-born babies. The need for disability allowance was significantly less common in the MP and LP groups than in the VP cases. These results could be used to counsel parents and to plan for follow-up with of MP and LP newborns. Future studies should create and evaluate guidelines for management, and risk assessment should be established for LP and MP infants.
Read more14Neural injury markers to predict neonatal complications in intrauterine growth restriction
We assessed the neural injury markers (NIMs) in maternal and umbilical blood in preterm deliveries with and without intrauterine growth restriction (IUGR), and relationship between NIMs and neonatal complications.Deliveries between 24 and 34 weeks’ gestation with (study group) and without (control group) IUGR were included to the study. Three NIMs (s100B, neurone-specific enolase [NSE] and alpha-foetoprotein [AFP]) were investigated in umbilical arterial, umbilical venous and maternal venous serum.Thirty-two IUGR and twenty-nine non-IUGR pregnancies with preterm delivery were included. Maternal and umbilical arterial s100B levels were significantly higher in the study group, whereas there was no relationship among IUGR, AFP and NSE levels. In the study group, umbilical venous s100B and NSE levels were associated with perinatal mortality (p = 0.012, 0.005, respectively), necrotising enterocolitis (NEC) (p = 0.001, 0.04, respectively) and need for intubation (p = 0.001, 0.007, respectively). Negative predictive values for perinatal mortality and NEC were 100% and for need for intubation it was 92.8% when both s100B and NSE were below the cutoff line determined by the receiver-operating characteristic curves.Perinatal mortality, NEC and need for intubation can be predicted by assessment of umbilical venous s100B and NSE measurement during birth in IUGR newborns.
Read more115Intrauterine Growth Restriction, Low Birth Weight, and Preterm Birth: Adverse Pregnancy Outcomes and Their Association With Maternal Periodontitis
It has been suggested that periodontitis is associated with systemic alterations such as adverse pregnancy outcomes. However, some conflicting results have been reported. This case-control study was conducted to determine the association between maternal periodontitis and preterm birth (PTB), low birth weight (LBW), and intrauterine growth restriction (IUGR). A total of 1,305 Brazilian women from multiethnic groups were enrolled and divided into four groups: control group (1,042 women who gave birth to infants with adequate gestational age and birth weight); PTB group (238 women, gestational age <37 complete weeks); LBW group (235 women, birth weight <2,500 g); and IUGR group (77 women who gave birth to infants with fetal growth retardation). Periodontitis was defined as the presence of at least four teeth with one or more sites with probing depth > or =4 mm and clinical attachment loss > or =3 mm. The effects of variables of interest, confounders, and interaction were tested through univariate and multivariate logistic regression tests. After adjusting for variables of interest, maternal periodontitis was retained in the final model for PTB (odds ratio [OR] = 1.77; 95% confidence interval [CI]: 1.12 to 2.59), LBW (OR = 1.67; 95% CI: 1.11 to 2.51), and IUGR (OR = 2.06; 95% CI: 1.07 to 4.19). When the interaction between periodontitis and previous PTB was tested, an OR of 5.94 (P <0.001), 9.12 (P <0.001), and 18.90 (P <0.001) was observed for PTB, LBW, and IUGR, respectively. Maternal periodontitis is associated with an increased risk for PTB, LBW, and IUGR. Results emphasize the importance of periodontal care in prenatal health programs.
Read more6Increased incidence of fetal growth restriction in association with breech presentation in preterm deliveries < 32 weeks.
Breech presentation and fetal growth restriction (FGR) are each related independently with preterm delivery. This study was designed to assess the possible relationship between breech presentation and FGR in deliveries at < 32 weeks' gestation. From an established database of 465 consecutive deliveries at < 32 weeks of nonhypertensive, nondiabetic patients with singleton nonanomalous fetuses, those in whom birth weight, body length, fetal presentation (vertex or breech), and amniotic fluid volume (AFV) had been assessed were studied. Fetal growth restriction (defined as symmetric if both birth weight and body length were < 10th percentile and asymmetric if only the birth weight was < 10th percentile) was studied in relation to maternal age, parity, tobacco use, fetal presentation, AFV, membrane status, and gestational age at delivery. Statistical analyses included contingency tables and analysis of variance, with p < 0.05 considered significant. Two hundred ninety-eight patients met the inclusion criteria. In these patients 85 (28.5%) fetuses were breech and 213 (71.5%) cephalic. A total of 56 (19%) fetuses were growth restricted. Of these, 31 (10.4%) were symmetrically and 25 (8.3%) asymmetrically growth restricted. The incidence of symmetric growth restriction in the breech-presenting fetuses was 16% (n = 14) versus 8% (n = 17) in the cephalic-presenting fetuses, and of asymmetric growth restriction 12% (n = 10) versus 7% (n = 15), (overall p = 0.03). Fetal growth restriction was not associated with significant differences in maternal age, parity, smoking, AFV, membrane status, or gestational age at delivery (each p > 0.10). In preterm deliveries at < 32 weeks' gestation, breech presentation is associated with an increased incidence of intrauterine growth restriction, independent of clinical confounders.
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