Abstract

OBJECTIVE: To explore the influence on perinatal outcome of different fetal monitoring strategies for preterm fetal growth restriction (FGR). DESIGN: Cohort analysis of individual participant data from the Growth Restriction Intervention Study (GRIT) and Trial of Umbilical and Fetal Flow in Europe (TRUFFLE) studies. SETTING: European multi-centre trials. POPULATION: All women from GRIT (n=238) and TRUFFLE (n=503), randomized between 26 and 32 weeks. METHODS: Women were categorized according to their monitoring-intervention method: A. immediate delivery (from GRIT), B. delayed delivery using conventional cardiotocography (CTG, from GRIT), C. delayed delivery using computerized CTG only (cCTG, from GRIT), D delayed delivery using cCTG only (from TRUFFLE) and E. delayed delivery using cCTG and ductus venosus (DV) Doppler (from TRUFFLE). PRIMARY OUTCOME MEASURE: Survival without impairment at two years. RESULTS: Gestational age at delivery and birth weight were similar in both studies. Fetal death rate was similar between GRIT and TRUFFLE, but neonatal and late death were more frequent in GRIT (18% vs. 6%; p<0.01). The primary outcome was least common in groups A (70%; 95% confidence interval [CI] 61-78), and B (69%; 95% CI 57-82), and increased with more advanced monitoring in C (80%; 95% CI 68-91) and D (77%; 95% CI 70-84) and was highest in E (84%; 95% CI 80-89); (p trend <0.01). CONCLUSIONS: This analysis supports that fetal monitoring for early FGR can best be performed by the combination of cCTG and DV Doppler assessment. TRIAL REGISTRATION: GRIT ISRCTN41358726 and TRUFFLE ISRCTN56204499. This article is protected by copyright. All rights reserved.