OP08.08: The association between fetal Doppler in the third trimester and admission to neonatal unit at term

Abstract

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...