IUGR fetuses < 32 weeks: from timing to delivery to medico-legal aspects

Objective: in a previous multicenter study we shown that the best condition to deliver an IUGR fetus is in the moment gestati age is > 28 weeks, birth weight 600 gr and absence of diastolic flow in the umbilical artery. In the present study we assessed the efficacy to counsel the patient if the above conditions are not meet. Methods: from 2006 to 2007 32 patients were referred to our Univesity hospital because of IUGR with gestational age < 28 weeks, EFW < 600gr and Doppler abnormalities in arterial and venous compartments. 12 patients were delivered on the decision made by the attending physitian and 20 were counseled before by a perinatologiest neonatologiest. Results: among the 12 patients not counseled all the newborn showed morbidity and there were 4 neonatal death, 6 patients for litigation. The 20 patients counseled, there were 2 neonatal deaths and all the fetuses showed morbidity. Conclusions: the best behaviour to avoid litigation is to counsel the patient and/or the couple to advise of a possible fetal death and the patient and/or the couple desire continuing pregnancy or a high morbidity and mortality rate in case of a cesarean section