This document summarizes two studies, TRUFFLE and GRIT, that explored fetal monitoring strategies for early-onset fetal growth restriction. GRIT compared immediate versus delayed delivery and found worse outcomes with immediate delivery. TRUFFLE compared conventional CTG, computerized CTG, and computerized CTG plus Doppler and found improved longterm infant outcomes with more advanced monitoring strategies. Both studies found the optimal method was a combination of computerized CTG and Doppler assessment.

1. OBGYN JOURNAL CLUB
March 2020

3. TRUFFLE n=503
Trial of umbilical and fatal
flow in Europe
Growth restricted
interventional study
GRIT n=548/n=238
Explore the effect on
perinatal outcome of different
Fetal monitoring strategies for
early-onset fetal growth Restriction (FGR)
When to deliver the baby?
and
What are the outcomes after 2 year F/U

4. GRIT
Between 1993- 2001
GA 24 -36 weeks
548 pregnant ladies
Singleton and multiple pregnancy
Clinical uncertainty for immediate
Or delayed delivery?
CTG and cCTG
UA Doppler
2 arms immediate vs delayed delivery
Outcome: Death or Neurodevelopmental delay
At or beyond 2 years
17.2% 6.5%

5. TRUFFLEBetween 2005- 2010
GA 26 -32 weeks
503 pregnant ladies
Singleton only
FGR criteria followed
Protocol for monitoring and delivery
3 arms
1. Reduced STV <3.5/<4
2. Early DV changes/DV >95/STV<SN
3.late DV changes/STV<SN
Outcome: Death or Neurodevelopmental delay
At or beyond 2 years
10%

6. DATA ANALYSIS ➤ All truffle patients -1
➤ GRIT (26-32 weeks @ entry)
➤ Primary outcome all infants (excluding infants
lost to F/U)
➤Analysis
➤ GRIT (immediate delivery NO CTG)
➤ GIRT (delayed delivery CTG)
➤ BOTH (cCTG with STV)
➤ TRUFFLE (cCTG with STV + DV Doppler)

7. COMPARING INTERVENTIONS
CTG
Conventional
CTG
Computerised
CTG
Computerised
+ DV Doppler
TRUFFLE
GRIT{
{

8. OVERALL TREND

9. COMPARING INTERVENTIONS BY GESTATIONAL AGE

10. COMPARING INTERVENTIONS BY GESTATIONAL AGE

11. DISCUSSION
➤ Improved longterm infant outcome using more advanced
strategies
➤ Difference in inclusion criteria
➤ Insufficient data regarding co-intervention such as steroids &
MgSO4
➤ 2 different tests to assess neurodevelopment outcome
➤ cCTG main advantage to provide numerical result which
allows for strict protocol

12. ODDS RATIOS FOR SURVIVAL WITHOUT NEURODEVELOPMENTAL IMPAIRMENT AT 2 YEARS
OPTIMAL METHOD FOR FETAL MONITORING IN
EARLY-ONSET FGR IS A COMBINATION OF CCTG AND DV
DOPPLER ASSESSMENT

13. THANK YOU