Role of Doppler ultrasound at time of diagnosis of late‐onset fetal growth restriction in predicting adverse perinatal outcome: prospective cohort study

Abstract

KEYWORDS: adverse perinatal outcome; late fetal growth restriction; middle cerebral artery Doppler; placental cerebral ratio; umbilical artery Doppler; umbilical vein flow; uterine artery Doppler CONTRIBUTIONWhat are the novel findings of this work? In late-onset fetal growth restriction, at the time of diagnosis, only umbilical vein blood flow normalized by abdominal circumference showed moderate accuracy in predicting adverse perinatal outcome, while the diagnostic performances of both cerebroplacental ratio and uterine artery pulsatility index were low.What are the clinical implications of this work? Assessment of umbilical vein blood flow at the time of diagnosis of late-onset fetal growth restriction may play a role in identifying pregnancies at higher risk of morbidity. ABSTRACTObjective Pregnancies complicated by late-onset fetal growth restriction (FGR) are at increased risk of shortand long-term morbidities. Despite this, identification of cases at higher risk of adverse perinatal outcome, at the time of FGR diagnosis, is challenging. The aims of this study were to elucidate the strength of association between fetoplacental Doppler indices at the time of diagnosis of late-onset FGR and adverse perinatal outcome, and to determine their predictive accuracy.(EFW) or abdominal circumference (AC) < 3 rd centile, or EFW or AC < 10 th centile and umbilical artery (UA) pulsatility index (PI) > 95 th centile or cerebroplacental ratio (CPR) < 5 th centile, diagnosed after 32 weeks. EFW, uterine artery PI, UA-PI, fetal middle cerebral artery (MCA) PI, CPR and umbilical vein blood flow normalized for fetal abdominal circumference (UVBF/AC) were recorded at the time of the diagnosis of FGR. Doppler variables were expressed as Z-scores for gestational age. Composite adverse perinatal outcome was defined as the occurrence of at least one of emergency Cesarean section for fetal distress, 5-min Apgar score < 7, umbilical artery pH < 7.10 and neonatal admission to the special care unit. Logistic regression analysis was used to elucidate the strength of association between different ultrasound parameters and composite adverse perinatal outcome, and receiver-operating-characteristics (ROC)-curve analysis was used to determine their predictive accuracy. ResultsIn total, 243 consecutive singleton pregnancies complicated by late-onset FGR were included. Composite adverse perinatal outcome occurred in 32.5% (95% CI, 26.7-38.8%) of cases. In pregnancies with composite adverse perinatal outcome, compared with those without, mean uterine artery PI Z-score (2.23 ± 1.34 vs 1.88 ± 0.89, P = 0.02) was higher, while Z-scores of UVBF/AC (−1.93 ± 0.88 vs −0.89 ± 0.94, P ≤ 0.0001), MCA-PI (−1.56 ± 0.93 vs −1.22 ± 0.84, P = 0.004) and CPR (−1.89 ± 1.12 vs −1.44 ± 1.02, P = 0.002) were lower. On multivariable logistic regression analysis, Z-scores of mean uterine artery PI (P = 0.04), CPR (P = 0.002) and UVBF/AC (P = 0.001) were associated 794 Rizzo et al.independently with composite adverse perinatal outcome. UVBF/AC Z-score had an area un...

Fetal Umbilical Vein Flow in the Classification of Fetuses with Growth Restriction

“…Similar evidence of significant QUV reduction in FGR fetuses was shown in several previous studies on this topic [13,15,21,22]. Rigano et al [21] selected an early-FGR population with severe artery Doppler alterations.…”

Assessment of renal volume by 3D VOCAL Ultrasonography method in late-onset growth-restricted fetuses with normal amniotic fluid index

“…In our study, no statistically significant difference between the two groups was observed for fetal MCA S/D or PI values. This result can be interpreted as our FGR group was not exposed to the brain sparing effect or redistribution due to FGR, and it is known that late-onset FGR does not always associate with the deprived blood supply of fetal organs [17,18].…”

Detection and clinical outcome of small‐for‐gestational‐age fetuses in the third trimester—A comparison between routine ultrasound examination and examination on indication

“…Similarly important is to avoid unnecessary interventions in false‐positive cases. In such clinical protocols, fetoplacental and uteroplacental Doppler velocimetry will have a given place 20,32 …”