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.