***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Aims : Severe preterm fetal growth restriction ( FGR ) remote from term is problematic . We aim ed to investigate the effect of maternally-administered antithrombin on maternal and neonatal outcomes . A prospect i ve , one-arm , pilot study was performed in 14 women with severe FGR ( ≤5th centile ) at < 28 weeks of gestation , without hypertensive disorders . Maternal plasma concentrations of soluble Feline McDonough Sarcoma (FMS)-like trypsin kinase-1 ( sFlt-1 ) and placental growth factor ( PlGF ) were measured and categorized into three groups : group 1 ; low sFlt-1 and high PlGF , group 2 ; moderate sFlt-1 and low PlGF , and group 3 ; high sFlt-1 and low PlGF . Antithrombin was administered for 3 days . The incidence of perinatal mortality , infant morbidity , and the period of pregnancy prolongation were compared . Results : In group 1 ( n=4 ) , their pregnancies were extended for longer periods and the maternal and infant outcomes were good . The prolongation periods were shorter in groups 2 ( n=3 ) and 3 ( n=7 ) , which result ed in poor maternal [ severe preeclampsia or hemolysis , elevated liver enzymes , and low platelet count ( HELLP ) syndrome ] and infant outcomes . Conclusions : The evaluation of the maternal sFlt-1 and PlGF at 21–27 weeks of gestation is useful in the managements of severe FGR . Antithrombin treatment could prolong the pregnancies with low sFlt-1 and high PlGF without negatively affecting maternal or fetal health BACKGROUND No consensus exists for the best way to monitor and when to trigger delivery in mothers of babies with fetal growth restriction . We aim ed to assess whether changes in the fetal ductus venosus Doppler waveform ( DV ) could be used as indications for delivery instead of cardiotocography short-term variation ( STV ) . METHODS In this prospect i ve , European multicentre , unblinded , r and omised study , we included women with singleton fetuses at 26 - 32 weeks of gestation who had very preterm fetal growth restriction ( ie , low abdominal circumference [ < 10th percentile ] and a high umbilical artery Doppler pulsatility index [ > 95th percentile ] ) . We r and omly allocated women 1:1:1 , with r and omly sized blocks and stratified by participating centre and gestational age ( < 29 weeks vs ≥29 weeks ) , to three timing of delivery plans , which differed according to antenatal monitoring strategies : reduced cardiotocograph fetal heart rate STV ( CTG STV ) , early DV changes ( pulsatility index > 95th percentile ; DV p95 ) , or late DV changes ( A wave [ the deflection within the venous waveform signifying atrial contraction ] at or below baseline ; DV no A ) . The primary outcome was survival without cerebral palsy or neurosensory impairment , or a Bayley III developmental score of less than 85 , at 2 years of age . We assessed outcomes in surviving infants with known outcomes at 2 years . We did an intention to treat study for all participants for whom we had data . Safety outcomes were deaths in utero and neonatal deaths and were assessed in all r and omly allocated women . This study is registered with IS RCT N , number 56204499 . FINDINGS Between Jan 1 , 2005 and Oct 1 , 2010 , 503 of 542 eligible women were r and omly allocated to monitoring groups ( 166 to CTG STV , 167 to DV p95 , and 170 to DV no A ) . The median gestational age at delivery was 30·7 weeks ( IQR 29·1 - 32·1 ) and mean birthweight was 1019 g ( SD 322 ) . The proportion of infants surviving without neuroimpairment did not differ between the CTG STV ( 111 [ 77 % ] of 144 infants with known outcome ) , DV p95 ( 119 [ 84 % ] of 142 ) , and DV no A ( 133 [ 85 % ] of 157 ) groups ( ptrend=0·09 ) . 12 fetuses ( 2 % ) died in utero and 27 ( 6 % ) neonatal deaths occurred . Of survivors , more infants where women were r and omly assigned to delivery according to late ductus changes ( 133 [ 95 % ] of 140 , 95 % , 95 % CI 90 - 98 ) were free of neuroimpairment when compared with those r and omly assigned to CTG ( 111 [ 85 % ] of 131 , 95 % CI 78 - 90 ; p=0.005 ) , but this was accompanied by a non-significant increase in perinatal and infant mortality . INTERPRETATION Although the difference in the proportion of infants surviving without neuroimpairment was non-significant at the primary endpoint , timing of delivery based on the study protocol using late changes in the DV waveform might produce an improvement in developmental outcomes at 2 years of age . FUNDING ZonMw , The Netherl and s and Dr Hans Ludwig Geisenhofer Foundation , Germany OBJECTIVE The objective of the study was to describe neurodevelopmental outcome at the age of 4.5 years in 216 children , born after expectant management of severe early-onset hypertensive complications of pregnancy . STUDY DESIGN This was a prospect i ve follow-up study until age 4.5 years from maternal admission onward . Developmental outcome measurements included child intelligence quotient and behavioral , motor , and neurological outcome . Abnormal composite outcome ( perinatal mortality or abnormal developmental outcome ) was studied in relation to gestational age ( GA ) , birthweight ( BW ) , and perinatal variables . RESULTS Fetal and neonatal mortality was 9 % and 8 % , respectively . Of the 178 survivors , 149 ( 84 % ) were seen for follow-up . Mean GA was 31.4 weeks and 90 % were born growth restricted . Abnormal developmental outcome occurred in 20 % and abnormal composite outcome in 37 % . CONCLUSION Perinatal mortality or abnormal child development occurs in one third of pregnancies with early-onset and severe hypertensive complications and is highest in the lowest GA and BW ranges OBJECTIVES Few data exist for counseling and perinatal management of women after an antenatal diagnosis of early-onset fetal growth restriction . Yet , the consequences of preterm delivery and its attendant morbidity for both mother and baby are far reaching . The objective of this study was to describe perinatal morbidity and mortality following early-onset fetal growth restriction based on time of antenatal diagnosis and delivery . METHODS We report cohort outcomes for a prospect i ve multicenter r and omized management study of fetal growth restriction ( Trial of R and omized Umbilical and Fetal Flow in Europe ( TRUFFLE ) ) performed in 20 European perinatal centers between 2005 and 2010 . Women with a singleton fetus at 26 - 32 weeks of gestation , with abdominal circumference < 10(th ) percentile and umbilical artery Doppler pulsatility index > 95(th ) percentile , were recruited . The main outcome measure was a composite of fetal or neonatal death or severe morbidity : survival to discharge with severe brain injury , bronchopulmonary dysplasia , proven neonatal sepsis or necrotizing enterocolitis . RESULTS Five-hundred and three of 542 eligible women formed the study group . Mean ± SD gestational age at diagnosis was 29 ± 1.6 weeks and mean ± SD estimated fetal weight was 881 ± 217 g ; 12 ( 2.4 % ) babies died in utero . Gestational age at delivery was 30.7 ± 2.3 weeks , and birth weight was 1013 ± 321 g. Overall , 81 % of deliveries were indicated by fetal condition and 97 % were by Cesarean section . Of 491 liveborn babies , outcomes were available for 490 amongst whom there were 27 ( 5.5 % ) deaths and 118 ( 24 % ) babies suffered severe morbidity . These babies were smaller at birth ( 867 ± 251 g ) and born earlier ( 29.6 ± 2.0 weeks ) . Death and severe morbidity were significantly related to gestational age , both at study entry and delivery and also with the presence of maternal hypertensive morbidity . The median time to delivery was 13 days for women without hypertension , 8 days for those with gestational hypertension , 4 days for pre-eclampsia and 3 days for HELLP syndrome . CONCLUSIONS Fetal outcome in this study was better than expected from contemporary reports : perinatal death was uncommon ( 8 % ) and 70 % survived without severe neonatal morbidity . The intervals to delivery , death and severe morbidity were related to the presence and severity of maternal hypertensive conditions OBJECTIVE To test the effect of aspirin and omega 3 on fetal weight as well as feto-maternal blood flow in asymmetrical intrauterine growth restriction ( IUGR ) . STUDY DESIGN This study is a clinical ly registered ( NCT02696577 ) , open , parallel , r and omized controlled trial , conducted at Assiut Woman 's Health Hospital , Egypt including 80 pregnant women ( 28 - 30 weeks ) with IUGR . They were r and omized either to group I : aspirin or group II : aspirin plus omega 3 . The primary outcome was the fetal weight after 6 weeks of treatment . Secondary outcomes included Doppler blood flow changes in both uterine and umbilical arteries , birth weight , time and method of delivery and admission to NICU . The outcome variables were analyzed using paired and unpaired t-test . RESULTS The estimated fetal weight increased significant in group II more than group I ( p=0.00 ) . The uterine and umbilical arteries blood flow increased significantly in group II ( p<0.05 ) . The birth weight in group II was higher than that observed in group I ( p<0.05 ) . CONCLUSION The using of aspirin with omega 3 is more effective than using aspirin only in increasing fetal weight and improving utero-placental blood flow in IUGR AIM We design ed a safety and dose-finding trial of tadalafil administered for fetal growth restriction ( FGR ) . METHODS Three cases were initially commenced on 10 mg/day and monitored for major adverse events . Should a major adverse event be observed in one or more of the three cases , an examination into its relation with tadalafil would be conducted by a safety evaluation committee . If one or more of these new cases exhibited the same adverse event , the trial would be stopped completely . If there were no harmful side-effects , the trial would be extended to three cases at 20 mg/day , and the protocol would continue as in the 10-mg/day dose . The 40-mg/day dosage was tried in six cases as the dosage was considered to be high . RESULTS The study population consisted of pregnant women with FGR .  Maternal adverse events in all doses were recorded as least one grade 1 adverse events , as tadalafil was considered acceptable from the viewpoint of the mothers . However , a dose of 40 mg/day increased the number of grade 1 adverse events . The only fetal adverse event was a case of intrauterine fetal death related to the velamentous insertion of the umbilical cord . Neonatal adverse events showed no correlation to tadalafil dose , but were found more frequently in preterm births and , therefore , were correlated to infant prematurity . CONCLUSION This safety and dose-finding trial showed that tadalafil had a favorable safety profile for pregnant women and fetuses with FGR AIM The prognosis for severe fetal growth restriction ( FGR ) with severe oligohydramnios before 26 weeks ' gestation ( WG ) is currently poor ; furthermore , its management is controversial . We report the innovative new management of FGR , such as therapeutic amnioinfusion and tocolysis . MATERIAL AND METHODS For FGR and severe oligohydramnios before 26 WG complicated with absent or reversed umbilical artery end-diastolic flow velocity and /or deceleration by ultrasonography , we performed transabdominal amnioinfusion with tocolysis .  Cases with multiple anomalies were excluded  . Survival rate and long-term prognosis were analyzed . RESULTS Among 570 FGR cases , 18 were included in the study . Mean diagnosis and delivery were at 22.6 ± 2.0 and 28.7 ± 3.3 WG .  Median birthweight  was 625 g ( -4.2 st and ard deviation ) . Final survival rate was 11/13 ( 85 % ) . There were five fetal deaths . In seven cases , oligohydramnios improved . Growth was detected in 10/18 fetuses . Furthermore , 8/8 decelerations , 4/12 cases of reversed umbilical artery end-diastolic flow velocity , 7/14 cases of brain-sparing effect , and 6/13 venous Doppler abnormalities were improved . When we detected umbilical cord compression , 8/10 cases were rescued . Eleven infants were followed up for an average of 5 years ; one case of cerebral palsy with normal development and  
    Output:
    
Neurodevelopmental impairment was assessed in a minority of surviving children .