Longitudinal Doppler Assessments in Late Preterm Fetal Growth Restriction.

Mylrea-Foley, Bronacha; Wolf, Hans; Stampalija, Tamara; Lees, Christoph; Arabin, B; Berger, A; Bergman, E; Bhide, A; Bilardo, C M; Breeze, A C; Brodszki, J; Calda, P; Cetin, I; Cesari, E; Derks, J; Ebbing, C; Ferrazzi, E; Ganzevoort, W; Frusca, T; Gordijn, S J; ... (2023). Longitudinal Doppler Assessments in Late Preterm Fetal Growth Restriction. Ultraschall in der Medizin, 44(1), pp. 56-67. Thieme 10.1055/a-1511-8293

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PURPOSE

To assess the longitudinal variation of the ratio of umbilical and cerebral artery pulsatility index (UCR) in late preterm fetal growth restriction (FGR).

MATERIALS AND METHODS

A prospective European multicenter observational study included women with a singleton pregnancy, 32+ 0-36+ 6, at risk of FGR (estimated fetal weight [EFW] or abdominal circumference [AC] < 10th percentile, abnormal arterial Doppler or fall in AC from 20-week scan of > 40 percentile points). The primary outcome was a composite of abnormal condition at birth or major neonatal morbidity. UCR was categorized as normal (< 0.9) or abnormal (≥ 0.9). UCR was assessed by gestational age at measurement interval to delivery, and by individual linear regression coefficient in women with two or more measurements.

RESULTS

856 women had 2770 measurements; 696 (81 %) had more than one measurement (median 3 (IQR 2-4). At inclusion, 63 (7 %) a UCR ≥ 0.9. These delivered earlier and had a lower birth weight and higher incidence of adverse outcome (30 % vs. 9 %, relative risk 3.2; 95 %CI 2.1-5.0) than women with a normal UCR at inclusion. Repeated measurements after an abnormal UCR at inclusion were abnormal again in 67 % (95 %CI 55-80), but after a normal UCR the chance of finding an abnormal UCR was 6 % (95 %CI 5-7 %). The risk of composite adverse outcome was similar using the first or subsequent UCR values.

CONCLUSION

An abnormal UCR is likely to be abnormal again at a later measurement, while after a normal UCR the chance of an abnormal UCR is 5-7 % when repeated weekly. Repeated measurements do not predict outcome better than the first measurement, most likely due to the most compromised fetuses being delivered after an abnormal UCR.

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