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

Dr Ed Johnstone, Professor Alexander Heazell, Dr Lynne Warrander

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.

Fetal growth restriction (FGR) is when a baby is growing less 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 extreme early onset fetal growth restriction, or eFGR.

At the moment, there is almost no research on how to help women who have eFGR babies. We don’t know how many people it affects, and different doctors respond to it in different ways. Most importantly, we don’t know the best way that we can help parents affected by eFGR. Going through an eFGR pregnancy can be very upsetting, as it is unclear how best to help the baby survive.

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 are conducting to help us to understand the challenges we face when helping women with eFGR babies.

Improving FGR counselling to parents

We are looking at NHS Scotland maternity data to see how common eFGR is and to calculate survival rates by gestation and birthweight, to improve the counselling given to parents.

Analysing data from previous eFGR pregnancies

We are analysing detailed antenatal and ultrasound data from over 150 eFGR pregnancies managed through the Manchester Placenta Clinic to see if we can find anything to predict pregnancy outcome. An exploratory study of 156 cases from 2009-2017 (94 alive at discharge, 39 stillbirths, 23 neonatal/infant deaths) suggests that EFW, amniotic fluid index, umbilical artery Doppler flow and placental biometry could be factors.

Comparing fetal heart rate patterns

We are comparing fetal heart rate patterns in normal and eFGR-affected pregnancies, to see if this gives us any further information. To date, 30 low-risk and 24 eFGR patients have taken part.

Timescale

2015-2019

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Funding

This study is fully funded by Tommy's and takes place in a Tommy's centre

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