{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T14:46:48Z","timestamp":1790174808611,"version":"4.1.0"},"reference-count":16,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2017,9,5]],"date-time":"2017-09-05T00:00:00Z","timestamp":1504569600000},"content-version":"vor","delay-in-days":4,"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":[[2017,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>In the TRUFFLE (Trial of Randomized Umbilical and Fetal Flow in Europe) study on the outcome of early fetal growth restriction, women were allocated to one of three groups of indication for delivery according to the following monitoring strategies: (1) reduced fetal heart rate (FHR) short\u2010term variation (STV) on cardiotocography (CTG); (2) early changes in fetal ductus venosus (DV) waveform (DV\u2010p95); and (3) late changes in fetal DV waveform (DV\u2010no\u2010A). However, many infants per monitoring protocol were delivered because of safety\u2010net criteria, for maternal or other fetal indications, or after 32 weeks of gestation when the protocol was no longer applied. The objective of the present <jats:italic>posthoc<\/jats:italic> subanalysis was to investigate the indications for delivery in relation to 2\u2010year outcome in infants delivered before 32 weeks to further refine management proposals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We included all 310 cases of the TRUFFLE study with known outcome at 2 years' corrected age and seven fetal deaths, excluding seven cases with inevitable perinatal death. Data were analyzed according to the allocated fetal monitoring strategy in combination with the indication for delivery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, only 32% of liveborn infants were delivered according to the specified monitoring parameter for indication for delivery; 38% were delivered because of safety\u2010net criteria, 15% for other fetal reasons and 15% for maternal reasons. In the CTG\u2010STV group, 51% of infants were delivered because of reduced STV. In the DV\u2010p95 group, 34% of infants were delivered because of abnormal DV and, in the DV\u2010no\u2010A group, only 10% of infants were delivered accordingly. The majority of infants in the DV groups were delivered for the safety\u2010net criterion of spontaneous decelerations in FHR. Two\u2010year intact survival was highest in the DV groups combined compared with the CTG\u2010STV group (<jats:italic>P<\/jats:italic> = 0.05 for live births only, <jats:italic>P<\/jats:italic> = 0.21 including fetal death), with no difference between DV groups. A poorer outcome in the CTG\u2010STV group was restricted to infants delivered because of FHR decelerations in the safety\u2010net subgroup. Infants delivered because of maternal reasons had the highest birth weight and a non\u2010significantly higher intact survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In this subanalysis of infants delivered before 32 weeks, the majority were delivered for reasons other than the allocated monitoring strategy indication. Since, in the DV group,  CTG\u2010STV criteria were used as a safety net but in the CTG\u2010STV group, no DV safety\u2010net criteria were applied, we speculate that the slightly poorer outcome in the CTG\u2010STV group might be explained by the absence of DV data. The optimal timing of delivery of fetuses with early intrauterine growth restriction may therefore be best determined by monitoring them longitudinally, with both DV and CTG monitoring. Copyright \u00a9 2016 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.17361","type":"journal-article","created":{"date-parts":[[2016,11,14]],"date-time":"2016-11-14T21:54:54Z","timestamp":1479160494000},"page":"347-352","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":51,"title":["Fetal monitoring indications for delivery and 2\u2010year outcome  in 310 infants with fetal growth restriction delivered before 32 weeks' gestation in the TRUFFLE study"],"prefix":"10.1002","volume":"50","author":[{"given":"G. H. A.","family":"Visser","sequence":"first","affiliation":[{"name":"Department of Perinatology University Medical Center  Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. M.","family":"Bilardo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University Medical Center, University of Groningen  Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. B.","family":"Derks","sequence":"additional","affiliation":[{"name":"Department of Perinatology University Medical Center  Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Ferrazzi","sequence":"additional","affiliation":[{"name":"Department of Woman, Mother and Neonate, Buzzi Children's Hospital University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Fratelli","sequence":"additional","affiliation":[{"name":"Maternal\u2010Fetal Medicine Unit University of Brescia  Brescia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Frusca","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University Hospital  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7243-2115","authenticated-orcid":false,"given":"W.","family":"Ganzevoort","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Academic Medical Centre  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2104-5561","authenticated-orcid":false,"given":"C. C.","family":"Lees","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer Imperial College London  London UK"},{"name":"Department of Development and Regeneration KU Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Napolitano","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics University Federico II of Naples  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Todros","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Sant' Anna Hospital  Turin Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Wolf","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"}]},{"name":"TRUFFLE group investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,9,5]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)62049-3"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.13190"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.0960-7692.2001.00590.x"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.0960-7692.2002.00627.x"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000253215.79121.75"},{"key":"e_1_2_5_7_1","first-page":"314","article-title":"Numerical fetal heart rate analysis: nomograms, minimal duration of recording and intrafetal consistency","volume":"3","author":"Nijhuis IJM","year":"1998","journal-title":"Prenat Neonat Med"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0301-2115(99)00162-1"},{"key":"e_1_2_5_9_1","first-page":"673","article-title":"Short\u2010term fetal heart rate variation, decelerations, and umbilical flow velocity waveforms before labor","volume":"80","author":"Dawes GS","year":"1992","journal-title":"Obstet Gynecol"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1991.tb13489.x"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.6365"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(92)91821-Q"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1997.tb10969.x"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1159\/000264461"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1159\/000052972"},{"key":"e_1_2_5_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1701-2163(15)30382-0"},{"key":"e_1_2_5_17_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-994468"}],"container-title":["Ultrasound in Obstetrics &amp; Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fuog.17361","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fuog.17361","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.17361","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,26]],"date-time":"2023-09-26T21:20:12Z","timestamp":1695763212000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.17361"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,9]]},"references-count":16,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2017,9]]}},"alternative-id":["10.1002\/uog.17361"],"URL":"https:\/\/doi.org\/10.1002\/uog.17361","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,9]]},"assertion":[{"value":"2016-07-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-11-08","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-09-05","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}