What is the best way of helping women with very early fetal growth restriction?

Dr Lynne Warrander, Dr Emma Ingram, Dr Ed Johnstone, Professor Alexander Heazell

Babies who stop growing very early in pregnancy are at high risk of being stillborn. Tommy’s are trying to find out how we can help women who are affected.

Start: September 2016

End: August 2019

Why do we need this research?

Fetal growth restriction (FGR) is when a baby grows slower than it should do in the womb. Babies whose growth slows or stops early on in pregnancy are at a much higher risk of stillbirth. In very early cases – before 28 weeks of pregnancy, when the baby weighs less than 600g – there is a very low chance of survival. This is known as extreme early-onset fetal growth restriction, or eFGR.

At the moment, there is almost no research on how to help women who have babies with eFGR. We don’t know how many people it affects, and different doctors respond to it in different ways, meaning it can be difficult to give good advice to parents of eFGR babies.

Parents can be faced with tough decisions if their baby is very small. It may be a choice between delivering the baby when there is a very slim chance of survival, or not intervening, in which case stillbirth is almost certain.

Tommy’s want to change this. We need to understand eFGR better in order to provide the best support to parents and determine how best to intervene to reduce risk of stillbirth.

What’s happening in this project?

Our researchers have been studying eFGR in various ways, and so far, they have made three important discoveries.

Firstly, by studying maternity data from NHS Scotland, involving 950 cases of eFGR, they have determined that eFGR occurs in 3 out of 1,000 pregnancies. The team are now using the same data to work out survival rates for eFGR babies, based upon their weight and time in the womb.

Secondly, our researchers have identified methods using ultrasound that could help determine how likely that an eFGR baby will be stillborn. Analysing ultrasound data from almost 200 cases of eFGR, they found that low weight, slow growth speed, and abnormal blood flow in the umbilical cord and uterus could be combined to help calculate the chances of stillbirth.

Finally, the team have found that the heartbeat of eFGR babies is different to that of babies who are growing normally. However, more research is needed to determine how to use this information to predict the outlook for eFGR babies.

What difference will this project make?

Our scientists hope that their discoveries could lead to better ways to predict the outlook for babies experiencing extreme early-onset fetal growth restriction. This will help us provide better information to parents at a difficult time. This research could also reveal how doctors can best intervene to reduce the risk of the baby dying

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