More Maternal Vascular Malperfusion and Chorioamnionitis in Placentas After Expectant Management vs. Immediate Delivery in Fetal Growth Restriction at (Near) Term: A Further Analysis of the DIGITAT Trial
Objective: Management of late fetal growth restriction (FGR) is limited to adequate fetal monitoring and optimal timing of delivery. The Disproportionate Intrauterine Growth Intervention Trial At Term (DIGITAT) trial compared induction of labor with expectant management in pregnancies at (near) term...
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Frontiers Media S.A.
2019-04-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fendo.2019.00238/full |
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| author | Marjon E. Feenstra Mirthe H. Schoots Torsten Plösch Jelmer R. Prins Sicco A. Scherjon Albertus Timmer Harry van Goor Sanne J. Gordijn |
| author_facet | Marjon E. Feenstra Mirthe H. Schoots Torsten Plösch Jelmer R. Prins Sicco A. Scherjon Albertus Timmer Harry van Goor Sanne J. Gordijn |
| author_sort | Marjon E. Feenstra |
| collection | DOAJ |
| description | Objective: Management of late fetal growth restriction (FGR) is limited to adequate fetal monitoring and optimal timing of delivery. The Disproportionate Intrauterine Growth Intervention Trial At Term (DIGITAT) trial compared induction of labor with expectant management in pregnancies at (near) term complicated by suspected FGR. Findings of the DIGITAT trial were that expectant monitoring prolonged pregnancy for 10 days and increased birth weight with only 130 grams. This resulted in more infants born below the 2.3rd percentile compared to induction of labor, respectively, 12.5% in induction of labor and 30.6% in expectant monitoring group. The main placental lesions associated with FGR are maternal vascular malperfusion, fetal vascular malperfusion, and villitis of unknown etiology. We investigated whether placentas of pregnancies complicated with FGR in the expectant monitoring group reveal more and more severe pathology due to pregnancy prolongation.Material and methods: The DIGITAT trial was a multicenter, randomized controlled trial with suspected FGR beyond 36 + 0 weeks. We now analyzed all available cases (n = 191) for placental pathology. The macroscopic details were collected and histological slides were recorded and classified by a single perinatal pathologist, blinded for pregnancy details and outcome. The different placental lesions were scored based on the latest international criteria for placental lesions as defined in the Amsterdam Placental Workshop Group Consensus Statement.Results: The presence of maternal vascular malperfusion and chorioamnionitis were higher in the expectant management group (p < 0.05 and p < 0.01, respectively). No differences in placental weight and maturation of the placenta between the induction of labor and the expectant management group were seen. Fetal vascular malperfusion, villitis of unknown etiology and nucleated red blood cell count did not differ between the groups.Conclusion: Expectant management of late FGR is associated with increased maternal vascular malperfusion and chorioamnionitis. This may have implications for fetal and neonatal outcome, such as programming in the developing child influencing health outcomes later in life. |
| first_indexed | 2024-04-13T01:42:41Z |
| format | Article |
| id | doaj.art-17f012a4675843f886804388a7d5090c |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-04-13T01:42:41Z |
| publishDate | 2019-04-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Endocrinology |
| spelling | doaj.art-17f012a4675843f886804388a7d5090c2022-12-22T03:08:08ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922019-04-011010.3389/fendo.2019.00238432338More Maternal Vascular Malperfusion and Chorioamnionitis in Placentas After Expectant Management vs. Immediate Delivery in Fetal Growth Restriction at (Near) Term: A Further Analysis of the DIGITAT TrialMarjon E. Feenstra0Mirthe H. Schoots1Torsten Plösch2Jelmer R. Prins3Sicco A. Scherjon4Albertus Timmer5Harry van Goor6Sanne J. Gordijn7Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, NetherlandsDepartment of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, NetherlandsDepartment of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, NetherlandsDepartment of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, NetherlandsDepartment of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, NetherlandsDepartment of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, NetherlandsDepartment of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, NetherlandsDepartment of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, NetherlandsObjective: Management of late fetal growth restriction (FGR) is limited to adequate fetal monitoring and optimal timing of delivery. The Disproportionate Intrauterine Growth Intervention Trial At Term (DIGITAT) trial compared induction of labor with expectant management in pregnancies at (near) term complicated by suspected FGR. Findings of the DIGITAT trial were that expectant monitoring prolonged pregnancy for 10 days and increased birth weight with only 130 grams. This resulted in more infants born below the 2.3rd percentile compared to induction of labor, respectively, 12.5% in induction of labor and 30.6% in expectant monitoring group. The main placental lesions associated with FGR are maternal vascular malperfusion, fetal vascular malperfusion, and villitis of unknown etiology. We investigated whether placentas of pregnancies complicated with FGR in the expectant monitoring group reveal more and more severe pathology due to pregnancy prolongation.Material and methods: The DIGITAT trial was a multicenter, randomized controlled trial with suspected FGR beyond 36 + 0 weeks. We now analyzed all available cases (n = 191) for placental pathology. The macroscopic details were collected and histological slides were recorded and classified by a single perinatal pathologist, blinded for pregnancy details and outcome. The different placental lesions were scored based on the latest international criteria for placental lesions as defined in the Amsterdam Placental Workshop Group Consensus Statement.Results: The presence of maternal vascular malperfusion and chorioamnionitis were higher in the expectant management group (p < 0.05 and p < 0.01, respectively). No differences in placental weight and maturation of the placenta between the induction of labor and the expectant management group were seen. Fetal vascular malperfusion, villitis of unknown etiology and nucleated red blood cell count did not differ between the groups.Conclusion: Expectant management of late FGR is associated with increased maternal vascular malperfusion and chorioamnionitis. This may have implications for fetal and neonatal outcome, such as programming in the developing child influencing health outcomes later in life.https://www.frontiersin.org/article/10.3389/fendo.2019.00238/fullfetal growth restrictionplacental pathologyDIGITAT trialmaternal vascular malperfusionchorioamnionitis |
| spellingShingle | Marjon E. Feenstra Mirthe H. Schoots Torsten Plösch Jelmer R. Prins Sicco A. Scherjon Albertus Timmer Harry van Goor Sanne J. Gordijn More Maternal Vascular Malperfusion and Chorioamnionitis in Placentas After Expectant Management vs. Immediate Delivery in Fetal Growth Restriction at (Near) Term: A Further Analysis of the DIGITAT Trial Frontiers in Endocrinology fetal growth restriction placental pathology DIGITAT trial maternal vascular malperfusion chorioamnionitis |
| title | More Maternal Vascular Malperfusion and Chorioamnionitis in Placentas After Expectant Management vs. Immediate Delivery in Fetal Growth Restriction at (Near) Term: A Further Analysis of the DIGITAT Trial |
| title_full | More Maternal Vascular Malperfusion and Chorioamnionitis in Placentas After Expectant Management vs. Immediate Delivery in Fetal Growth Restriction at (Near) Term: A Further Analysis of the DIGITAT Trial |
| title_fullStr | More Maternal Vascular Malperfusion and Chorioamnionitis in Placentas After Expectant Management vs. Immediate Delivery in Fetal Growth Restriction at (Near) Term: A Further Analysis of the DIGITAT Trial |
| title_full_unstemmed | More Maternal Vascular Malperfusion and Chorioamnionitis in Placentas After Expectant Management vs. Immediate Delivery in Fetal Growth Restriction at (Near) Term: A Further Analysis of the DIGITAT Trial |
| title_short | More Maternal Vascular Malperfusion and Chorioamnionitis in Placentas After Expectant Management vs. Immediate Delivery in Fetal Growth Restriction at (Near) Term: A Further Analysis of the DIGITAT Trial |
| title_sort | more maternal vascular malperfusion and chorioamnionitis in placentas after expectant management vs immediate delivery in fetal growth restriction at near term a further analysis of the digitat trial |
| topic | fetal growth restriction placental pathology DIGITAT trial maternal vascular malperfusion chorioamnionitis |
| url | https://www.frontiersin.org/article/10.3389/fendo.2019.00238/full |
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