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Comparative analysis of 2-year outcomes in GRIT and TRUFFLE trials.

Ganzevoort, W; Thornton, JG; Marlow, N; Thilaganathan, B; Arabin, B; Prefumo, F; Lees, C; Wolf, H; GRIT Study Group; TRUFFLE Study Group (2020) Comparative analysis of 2-year outcomes in GRIT and TRUFFLE trials. Ultrasound Obstet Gynecol, 55 (1). pp. 68-74. ISSN 1469-0705 https://doi.org/10.1002/uog.20354
SGUL Authors: Thilaganathan, Baskaran

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Abstract

OBJECTIVE: To explore the effect on perinatal outcome of different fetal monitoring strategies for early-onset fetal growth restriction (FGR). METHODS: This was a cohort analysis of individual participant data from two European multicenter trials of fetal monitoring methods for FGR: the Growth Restriction Intervention Study (GRIT) and the Trial of Umbilical and Fetal Flow in Europe (TRUFFLE). All women from GRIT (n = 238) and TRUFFLE (n = 503) who were randomized between 26 and 32 weeks' gestation were included. The women were grouped according to intervention and monitoring method: immediate delivery (GRIT) or delayed delivery with monitoring by conventional cardiotocography (CTG) (GRIT), computerized CTG (cCTG) only (GRIT and TRUFFLE) or cCTG and ductus venosus (DV) Doppler (TRUFFLE). The primary outcome was survival without neurodevelopmental impairment at 2 years of age. RESULTS: Gestational age at delivery and birth weight were similar in both studies. Fetal death rate was similar between the GRIT and TRUFFLE groups, but neonatal and late death were more frequent in GRIT (18% vs 6%; P < 0.01). The rate of survival without impairment at 2 years was lowest in pregnancies that underwent immediate delivery (70% (95% CI, 61-78%)) or delayed delivery with monitoring by CTG (69% (95% CI, 57-82%)), increased in those monitored using cCTG only in both GRIT (80% (95% CI, 68-91%)) and TRUFFLE (77% (95% CI, 70-84%)), and was highest in pregnancies monitored using cCTG and DV Doppler (84% (95% CI, 80-89%)) (P < 0.01 for trend). CONCLUSIONS: This analysis supports the hypothesis that the optimal method for fetal monitoring in pregnancies complicated by early-onset FGR is a combination of cCTG and DV Doppler assessment. TRIAL REGISTRATION: GRIT ISRCTN41358726 and TRUFFLE ISRCTN56204499. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

Item Type: Article
Additional Information: © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Keywords: cardiotocography, ductus venosus, fetal growth restriction, monitoring, short-term variation, GRIT Study Group, TRUFFLE Study Group, Fetal growth restriction, cardiotocography, ductus venosus, monitoring, short term variation, 1114 Paediatrics and Reproductive Medicine, Obstetrics & Reproductive Medicine
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Ultrasound Obstet Gynecol
ISSN: 1469-0705
Language: eng
Dates:
DateEvent
1 January 2020Published
24 May 2019Published Online
10 May 2019Accepted
Publisher License: Publisher's own licence
Projects:
Project IDFunderFunder ID
94506556Netherlands Organisation for Health Research and Developmenthttp://dx.doi.org/10.13039/501100001826
UNSPECIFIEDMedical Research Councilhttp://dx.doi.org/10.13039/501100000265
UNSPECIFIEDEuropean Union Concerted ActionUNSPECIFIED
UNSPECIFIEDPrincess Beatrix FoundationUNSPECIFIED
PubMed ID: 31125465
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/110888
Publisher's version: https://doi.org/10.1002/uog.20354

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