Introduction
Fetal consequences of defective placentation with poor vascular flow
secondary to abnormal physiological transformation of the spiral
arteries are intrauterine growth restriction, oligohydramnios, abruptio
placentae, and adverse fetal biophysical score. In this context, the
fetuses resulting from pre-eclampsia pregnancies have an increased risk
of preterm birth and unfavorable perinatal and neonatal prognosis.
In order to reduce these complications, expectation management can be
used, when the situation allows. The conditions that impose emergency
therapeutic behavior are divided into maternal and fetal conditions. The
maternal conditions include high blood pressure values resistant to
antihypertensive treatment (greater than 160/110 mmHg); persistent,
treatment-resistant headache; epigastralgia or pain in the right
shoulder resistant to anti-algic treatment; visual disorders, motor
deficits or sensory disorders; stroke; myocardial infarction; HELLP
syndrome; newly developed renal failure or worsening of renal function;
pulmonary edema; eclampsia; and suspected abruptio placentae or vaginal
bleeding in the context of the placenta praevia1.
Fetal conditions that require emergency therapeutic action include a
biophysical score of 4 or less; intrauterine fetal death; minimal
chances of fetal survival in the context of fetal malformation
incompatible with life or extreme prematurity; changes in Doppler
velocimetry with inverted end-diastolic flow of the umbilical
artery2.
The decision to implement therapeutic intervention is made after the
complete clinical and paraclinical evaluation and the determination of
the risk/benefit ratio, both maternal and fetal. More specifically, the
biological evaluation should be performed prior to obstetrical decision
and should include: hemoleucogram; biochemical evaluation of renal
function, liver function, and markers of hemolysis; and urinary test for
evaluation of proteinuria. The fetal evaluation is based on the complete
obstetrical ultrasound examination, with assessment of fetal growth and
weight, respectively, as well as assessment of the volume of the
amniotic fluid and the fetal biophysical score along with the Doppler
velocimetry of the umbilical arteries, the mean cerebral artery and the
cerebroplacental ratio3.Both prematurity and
intrauterine growth restriction are the fetal complications most often
associated with preeclampsia. Intrauterine growth restriction is a
marker of fetal distress and an important risk factor for fetal
intrauterine degradation, and the onset of complications of prematurity
further contribute to a less favorable prognosis4.
The aim of our study was to evaluate the neonatal prognosis of preterm
births with and without growth restriction and term births with growth
restriction in order to improve decisional accuracy regarding the
termination of pregnancy.