New TRUFFLE: Neurodevelopmental and intermediate outcomes very preterm FGR

Question 1

TRUFFLE: 2 year Neurodevelopmental and intermediate perinatal outcomes in very preterm FGR

Answer 1

Randomised prospective
N= 542
multi centre, unblinded

Whether changes in fetal ductus venosus (DV) doppler could be used as indications for delivery instead of CTG short term variation (STV) for pregnancy with evidence of FGR

Lancet 2015
Lees et al

Question 2

TRUFFLE: 2 year Neurodevelopmental and intermediate perinatal outcomes in very preterm FGR

Answer 2

Singleton pregnancy, 26-32/40 with v early onset FGR – AC < 10th + UA PI > 95th
Randomised to different monitoring to time delivery
- Reduced CTG short term variation (STV)
- Early DV changes (DV PI > 95th)
- Late DV changes (A wave absent or reversed)

Question 3

Outcomes TRUFFLE: 2 year Neurodevelopmental and intermediate perinatal outcomes in very preterm FGR

Answer 3

• No sig diff survival without CP or neurosensory impairment [77% vs 83% vs 85%]
• IUFD/NND: not sig

NB: late DV changes – more had impairment-free survival cf CTG (95% vs 85%) but this was accompanied by non-sig inc in IUFD/NND

Conclusion
Though difference in no. surviving without neuro-impairment was non-significant, timing of delivery based on late DV changes might produce improved developmental outcomes at 2yo