{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T01:28:58Z","timestamp":1791854938864,"version":"4.3.4"},"reference-count":24,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2013,9,23]],"date-time":"2013-09-23T00:00:00Z","timestamp":1379894400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2013,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Few data exist for counseling and perinatal management of women after an antenatal diagnosis of early\u2010onset fetal growth restriction. Yet, the consequences of preterm delivery and its attendant morbidity for both mother and baby are far reaching. The objective of this study was to describe perinatal morbidity and mortality following early\u2010onset fetal growth restriction based on time of antenatal diagnosis and delivery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We report cohort outcomes for a prospective multicenter randomized management study of fetal growth restriction (Trial of Randomized Umbilical and Fetal Flow in Europe (<jats:styled-content style=\"fixed-case\">TRUFFLE<\/jats:styled-content>)) performed in 20 European perinatal centers between 2005 and 2010. Women with a singleton fetus at 26\u201332 weeks of gestation, with abdominal circumference &lt; 10<jats:sup>th<\/jats:sup> percentile and umbilical artery Doppler pulsatility index &gt; 95<jats:sup>th<\/jats:sup> percentile, were recruited. The main outcome measure was a composite of fetal or neonatal death or severe morbidity: survival to discharge with severe brain injury, bronchopulmonary dysplasia, proven neonatal sepsis or necrotizing enterocolitis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Five\u2010hundred and three of 542 eligible women formed the study group. Mean \u00b1 <jats:styled-content style=\"fixed-case\">SD<\/jats:styled-content> gestational age at diagnosis was 29 \u00b1 1.6 weeks and mean \u00b1 <jats:styled-content style=\"fixed-case\">SD<\/jats:styled-content> estimated fetal weight was 881 \u00b1 217  g; 12 (2.4%) babies died <jats:italic>in utero<\/jats:italic>. Gestational age at delivery was 30.7 \u00b1 2.3 weeks, and birth weight was 1013 \u00b1 321 g. Overall, 81% of deliveries were indicated by fetal condition and 97% were by Cesarean section. Of 491 liveborn babies, outcomes were available for 490 amongst whom there were 27 (5.5%) deaths and 118 (24%) babies suffered severe morbidity. These babies were smaller at birth (867 \u00b1 251 g) and born earlier (29.6 \u00b1 2.0 weeks). Death and severe morbidity were significantly related to gestational age, both at study entry and delivery and also with the presence of maternal hypertensive morbidity. The median time to delivery was 13 days for women without hypertension, 8 days for those with gestational hypertension, 4 days for pre\u2010eclampsia and 3 days for <jats:styled-content style=\"fixed-case\">HELLP<\/jats:styled-content> syndrome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Fetal outcome in this study was better than expected from contemporary reports: perinatal death was uncommon (8%) and 70% survived without severe neonatal morbidity. The intervals to delivery, death and severe morbidity were related to the presence and severity of maternal hypertensive conditions. Copyright \u00a9 2013 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.13190","type":"journal-article","created":{"date-parts":[[2014,1,6]],"date-time":"2014-01-06T10:31:12Z","timestamp":1389004272000},"page":"400-408","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":492,"title":["Perinatal morbidity and mortality in early\u2010onset fetal growth restriction: cohort outcomes of the trial of randomized umbilical and fetal flow in Europe (<scp>TRUFFLE<\/scp>)"],"prefix":"10.1002","volume":"42","author":[{"given":"C.","family":"Lees","sequence":"first","affiliation":[{"name":"Department of Obstetrics &amp; Gynaecology Rosie Hospital  Cambridge UK"},{"name":"Department of Obstetrics and Gynecology KU Leuven  Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Marlow","sequence":"additional","affiliation":[{"name":"Department of Academic Neonatology UCL Institute for Women's Health  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Arabin","sequence":"additional","affiliation":[{"name":"Department of Perinatology Isala Clinics Zwolle  Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. M.","family":"Bilardo","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, Department of Obstetrics and Gynaecology University Medical Centre Groningen  Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Brezinka","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Universit\u00e4tsklinik f\u00fcr Gyn\u00e4kologische Endokrinologie und Reproduktionsmedizin, Department f\u00fcr Frauenheilkunde  Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. B.","family":"Derks","sequence":"additional","affiliation":[{"name":"Perinatal Center Wilhelmina Children's Hospital  Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Duvekot","sequence":"additional","affiliation":[{"name":"Division of Obstetrics and Prenatal Medicine Department of Obstetrics and Gynaecology Erasmus MC Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Frusca","sequence":"additional","affiliation":[{"name":"Maternal\u2010Fetal Medicine Unit University of Brescia  Brescia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Diemert","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Fetal Medicine University Medical Center Hamburg\u2010Eppendorf  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Ferrazzi","sequence":"additional","affiliation":[{"name":"Children's Hospital, Buzzi University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W.","family":"Ganzevoort","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Academic Medical Centre  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Hecher","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Fetal Medicine University Medical Center Hamburg\u2010Eppendorf  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Martinelli","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics University Federico II of Naples Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Ostermayer","sequence":"additional","affiliation":[{"name":"Section of Perinatal Medicine, Department of Obstetrics and Gynecology Technical University  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. T.","family":"Papageorghiou","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit St George's Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Schlembach","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Medical University of Graz  Graz Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. T. 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