Topics: Neonatal Morbidity and Mortality, Systems-based Practice I dentifying whether a fetus is at risk for intrapartum hypoxia and other adverse conditions is challenging. Although smaller fetal size is more strongly associated with nonreassuring fetal status, many appropriate weight babies are also at risk for conditions such as cerebral palsy. A recent study suggested that fetal cerebroplacental ratio (CPR) measured within 72 hours of delivery, can successfully identify patients that will require obstetric intervention for intrapartum fetal compromise. The purpose of this study was to determine whether or not the CPR can in fact serve as a reliable indicator of both intrapartum fetal compromise and admission to a neonatal unit.The study was conducted from 2000 to 2013 in a single tertiary referral center and involved a retrospective analysis of prospectively collected data. Within 2 weeks of delivery, information on umbilical artery pulsatility index, middle cerebral artery pulsatility index, and CPR was collected for each case. Birth weights were converted into centiles and Doppler parameters were converted into multiples of the median, with reference ranges used to adjust for gestational age. Possible confounding variables were addressed through the use of logistic regression analysis.A total of 9772 singleton pregnancies were included in the study. Operative delivery in response to presumed fetal compromise occurred in 17.2% of cases, while admission to a neonatal unit occurred in 3.9% of cases. CPRs were lower in cases that required either operative delivery or admission to a neonatal unit (P < 0.01). Logistic regression showed that both CPR and birth weight were independently associated with an increased risk of operative delivery for presumed fetal compromise [adjusted odds ratio (OR), 0.67; 95% confidence interval (CI), 0.52-0.87; P = 0.003 and adjusted OR, 0.994; 95% CI, 0.992-0.997; P < 0.001, respectively). The association with birth weight persisted even when small-for-gestational-age cases were excluded. CPR was shown to be an independent indicator for admission to a neonatal unit at term (adjusted OR, 0.55; 95% CI, 0.33-0.92; P = 0.021), while birth weight was not (adjusted OR, 1.00; 95% CI, 0.99-1.00; P = 0.794).The findings of this study show that there is an association between low fetal CPR measured at term and the need for emergency operative delivery and admission to a neonatal unit. Even after the results were adjusted for potential confounders, this association remained significant. These results emphasize that Doppler assessment is a better indicator of fetal compromise than size alone. The authors recommend that future studies focus on how fetal hemodynamic status could be useful in predicting perinatal morbidity and guiding the best choice of delivery method.

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Objectives: To assess if angiogenic factors could improve first-trimester screening for the prediction of fetal growth restriction (FGR). Methods: A nested case control study drawn from a prospective first trimester cohort (2007)(2008)(2009)(2010)(2011)(2012). The outcome was the development of FGR (birthweight <10th centile with Doppler abnormalities). Logistic regression-based predictive models were developed for the prediction of early and late FGR, subdivided for abnormalities of umbilical artery. The model included the a priori risk (maternal characteristics), mean arterial pressure (MAP), uterine artery (UtA) Doppler (11-13 weeks), and the measurement of the angiogenic factors (8-11 weeks): placental growth factor (PlGF) and soluble Fms-like tyrosine kinase-1 (sFtl-1), normalized by logarithmic transformation. Results: Of the 9,167 participants, 248 (2.7%) were diagnosed as FGR, from which 43 fetuses (0.5%) were early FGR, and 205 (2.3%) late FGR. Significant contributions for the prediction of early FGR were black ethnicity, chronic hypertension, previous FGR, smoking, together with MAP, UtA, PlGF and sFlt-1. A model achieved detection rates (DR) of 81% and 88% for 5% and 10% false positive rates (FPR), respectively (AUC: 0.96 [95%CI: 0.94-0.99]), and PlGF/sFlt-1 improved it by 26%. In those cases (49%) without pre-eclampsia (PE) DR was 81% at 10% of FPR. For late FGR, significant contributions were previous FGR, autoimmune disease, smoking together with MAP, UtA, PlGF and sFlt-1. The model achieved DR of 57% and 64% at 5% and 10% of FPR, respectively (AUC: 0.80 [95%CI: 0.75-0.84]), and PlGF/sFlt-1 improved it by 20%. In those cases (70%) without PE DR was 59% at 10% of FPR. Conclusions: Angiogenic factors are essential for the prediction of FGR. For early FGR, even if the association with PE, the prediction in the first trimester is attainable. For the prediction of late FGR, not influenced by PE and difficult to achieve so early, angiogenic factors improved it substantially. OC10.05Dexamethasone on umbilical artery Doppler in intrauterine growth restricted fetuses from pregnancies complicated by pre-eclampsia Objectives: Fetal cerebroplacental ratio (CPR) at term is emerging as an important proxy for placental insufficiency and a marker of fetal compromise. The aim of this study was to evaluate the association 26

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Objectives:To evaluate the clinical value of cerebroaortic ratio in predicting the risk of Caesarean section (CS) non-reassuring fetal status (NRFS) in term small-for-gestational-age (SGA) fetuses with normal umbilical artery Doppler. Methods: Combination of middle cerebral artery (MCA) and Aortic Isthmus (AoI) pulsatility indices (PI) in the cerebroaortic ratio (CAR = MCA/AoI) was evaluated within 1 week before labour induction in a cohort of 106 singleton consecutive SGA fetuses with normal umbilical artery PI (<95th centile) delivered above 37 weeks. The contribution of CAR to predict CS for NRFS alone or in combination with MCA PI, cerebroplacental ratio (CPR), AoI PI and uterine artery Doppler was assessed by logistic regression and decision tree analysis. Results: Individual Doppler abnormalities were significantly associated with the risk of CS for NRFS, with an odds ratio (OR) of 4.9 (95% confidence intervals (CI) 4.9-11.9, p < 0.001) for abnormal CAR (<0.48), OR of 4.2 (95% CI 1.6-10.7, p = 0.003) for abnormal MCA (<5th centile), OR of 3.9 (95% CI 1.6-9.8, p = 0.003) for abnormal CPR (<5th centile) and OR of 2.8 (95% CI 1.1-7.3, p = 0.03) for abnormal uterine artery Doppler (mean PI >95th centile). Decision tree analysis combining abnormalities in CAR, MCA, CPR, and uterine artery Doppler identified the CAR as the best individual predictor discriminating two groups with high (51.0%) and low risk (17.5%). Conclusions: Combination of brain Doppler and Aortic Isthmus in the cerebroaortic ratio better discriminates term SGA fetuses at risk of adverse perinatal outcome. OP08.08The association between fetal Doppler in the third trimester and admission to neonatal unit at term Objectives: Fetal cerebroplacental ratio (CPR) at term is emerging as an important proxy for placental insufficiency and a marker of fetal compromise. The extent to which these fetal Doppler changes are related to neonatal clinical outcomes has not been systematically assessed. The aim of this study was to evaluate the association between estimated fetal weight (EFW), middle cerebral artery (MCA), umbilical artery (UA) and CPR Doppler indices and neonatal unit (NNU) admission at term.Methods: This was a retrospective cohort study in a single tertiary referral center from 2002 to 2012. The UA pulsatility index (PI), MCA PI and CPR were recorded at 34 + 0-35 + 6 weeks. Fetal weight was converted into centiles, and Doppler parameters into multiples of the median (MoM) adjusting for gestational age (GA) using reference ranges. Logistic regression analysis was performed to identify and adjust for potential confounders. Results: We identified 2518 pregnancies that had a scan at 34 + 0-35 + 6 weeks and delivered ≥ 37 weeks. In the 2485 pregnancies included in the analysis, the UA PI MoM was significantly higher, while MCA PI and CPR MoM were significantly lower, in neonates requiring NNU admission (p < 0.05). However, the EFW centile was not significantly different between the two study groups (p = 0.087). According to the multivariate logistic...