{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T07:21:36Z","timestamp":1790493696288,"version":"4.1.0"},"reference-count":10,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2017,6,1]],"date-time":"2017-06-01T00:00:00Z","timestamp":1496275200000},"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":[[2017,6]]},"abstract":"ABSTRACT<\/jats:title>Objectives<\/jats:title>In the recent TRUFFLE<\/jats:styled-content> study, it appeared that, in pregnancies complicated by fetal growth restriction (FGR<\/jats:styled-content>) between 26 and 32 weeks' gestation, monitoring of the fetal ductus venosus (DV<\/jats:styled-content>) waveform combined with computed cardiotocography (CTG<\/jats:styled-content>) to determine timing of delivery increased the chance of infant survival without neurological impairment. However, concerns with the interpretation were raised, as DV<\/jats:styled-content> monitoring appeared to be associated with a non\u2010significant increase in fetal death, and some infants were delivered after 32 weeks, at which time the study protocol no longer applied. This secondary sensitivity analysis of the TRUFFLE<\/jats:styled-content> study focuses on women who delivered before 32 completed weeks' gestation and analyzes in detail the cases of fetal death.<\/jats:p><\/jats:sec>Methods<\/jats:title>Monitoring data of 317 pregnancies with FGR<\/jats:styled-content> that delivered before 32 weeks were analyzed, excluding those with absent outcome data or inevitable perinatal death. Women were allocated randomly to one of three groups of indication for delivery according to the following monitoring strategies: (1) reduced fetal heart rate short\u2010term variation (STV<\/jats:styled-content>) on CTG<\/jats:styled-content>; (2) early changes in fetal DV<\/jats:styled-content> waveform; and (3) late changes in fetal DV<\/jats:styled-content> waveform. Primary outcome was 2\u2010year survival without neurological impairment. The association of the last monitoring data before delivery and infant outcome was assessed by multivariable analysis.<\/jats:p><\/jats:sec>Results<\/jats:title>Two\u2010year survival without neurological impairment occurred more often in the two DV<\/jats:styled-content> groups (both 83%) than in the CTG\u2010STV<\/jats:styled-content> group (77%), however, the difference was not statistically significant (P<\/jats:italic>\u2009=\u20090.21). Among the surviving infants in the DV<\/jats:styled-content> groups, 93% were free of neurological impairment vs<\/jats:italic> 85% of surviving infants in the CTG\u2010STV<\/jats:styled-content> group (P<\/jats:italic>\u2009=\u20090.049). All fetal deaths (n<\/jats:italic>\u2009=\u20097) occurred in the groups with DV<\/jats:styled-content> monitoring. Of the monitoring parameters obtained shortly before fetal death in these seven cases, an abnormal CTG<\/jats:styled-content> was observed in only one case. Multivariable regression analysis of factors at study entry demonstrated that a later gestational age, higher estimated fetal weight\u2010to\u201050th<\/jats:sup> percentile ratio and lower umbilical artery pulsatility index (PI<\/jats:styled-content>)\/fetal middle cerebral artery\u2010PI<\/jats:styled-content> ratio were significantly associated with normal outcome. Allocation to DV<\/jats:styled-content> monitoring had a smaller effect on outcome, but remained in the model (P<\/jats:italic>\u2009<\u20090.1). Abnormal fetal arterial Doppler before delivery was significantly associated with adverse outcome in the CTG\u2010STV<\/jats:styled-content> group. In contrast, abnormal DV<\/jats:styled-content> flow was the only monitoring parameter associated with adverse outcome in the DV<\/jats:styled-content> groups, while fetal arterial Doppler, STV<\/jats:styled-content> below the cut\u2010off used in the CTG\u2010STV<\/jats:styled-content> group and recurrent decelerations in fetal heart rate were not.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>In accordance with the findings of the TRUFFLE<\/jats:styled-content> study on monitoring and intervention management of very preterm FGR<\/jats:styled-content>, we found that the proportion of infants surviving without neuroimpairment was not significantly different when the decision for delivery was based on changes in DV<\/jats:styled-content> waveform vs<\/jats:italic> reduced STV<\/jats:styled-content> on CTG<\/jats:styled-content>. The uneven distribution of fetal deaths towards the DV<\/jats:styled-content> groups was probably a chance effect, and neurological outcome was better among surviving children in these groups. Before 32 weeks, delaying delivery until abnormalities in DV\u2010PI<\/jats:styled-content> or STV<\/jats:styled-content> and\/or recurrent decelerations in fetal heat rate occur, as defined by the study protocol, is likely to be safe and possibly benefits long\u2010term outcome. Copyright \u00a9 2017 ISUOG. Published by John Wiley & Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.17433","type":"journal-article","created":{"date-parts":[[2017,2,9]],"date-time":"2017-02-09T15:42:52Z","timestamp":1486654972000},"page":"769-777","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":61,"title":["How to monitor pregnancies complicated by fetal growth restriction and delivery before 32 weeks: post\u2010hoc<\/i> analysis of TRUFFLE<\/scp> study"],"prefix":"10.1002","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7243-2115","authenticated-orcid":false,"given":"W.","family":"Ganzevoort","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Academic Medical Centre Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Mensing Van Charante","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Academic Medical Centre Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Thilaganathan","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, St George's University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Prefumo","sequence":"additional","affiliation":[{"name":"Maternal Fetal Medicine Unit University of Brescia Brescia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Arabin","sequence":"additional","affiliation":[{"name":"Center for Mother and Child of the Phillips University Marburg Germany"}],"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 Medical University of Innsbruck 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":"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":"J. 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":"E.","family":"Ferrazzi","sequence":"additional","affiliation":[{"name":"Children's Hospital, Buzzi University of Milan Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Frusca","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Maggiore Hospital, University of Parma Parma Italy"}],"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":"N.","family":"Marlow","sequence":"additional","affiliation":[{"name":"University College London Institute for Women's Health Ringgold Standard Institution\u00a0\u2013\u00a0Neonatology London UK"}],"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 University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Schlembach","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Vivantes Clinic Neuk\u00f6lln Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. T. M.","family":"Schneider","sequence":"additional","affiliation":[{"name":"Section of Perinatal Medicine, Department of Obstetrics and Gynecology Technical University Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Todros","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Turin Turin Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Valcamonico","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Maggiore Hospital, University of Parma Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. H. 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