A. Iraola

Neurodevelopmental outcome in 2‐year‐old infants who were small‐for‐gestational age term fetuses with cerebral blood flow redistribution

To assess the neurodevelopmental outcome at 2 years of age of children who had been small‐for‐gestational‐age (SGA) term babies with cerebral blood flow redistribution.

Growth deficit in term small-for-gestational fetuses with normal umbilical artery Doppler is associated with adverse outcome

Abstract Aim: The association between the growth deficit and the occurrence of adverse outcome was analyzed in a cohort of small-for-gestational age fetuses delivered at term. Methods: A cohort of consecutive singleton fetuses suspected of being SGA during the late third trimester and delivered beyond 37 weeks was selected. Growth deficit area was calculated as that between the individual 10th centile curve of the customized optimal fetal weight and the individual fetal growth curve. Results: A total of 55 women were included. Of these, 16 had 28 adverse events: eight cases of umbilical artery pH<7.15, 9 cases of caesarean section for fetal distress and 11 cases of admission to neonatal intensive care unit. Whereas the mean area of growth deficit was 8.8 kg×week units (SD 7.6) for cases with normal outcomes, it was 13.9 (SD 8.04) for cases with adverse outcomes (P=0.03). A growth area deficit >10 units, predicted the occurrence of adverse outcome with a sensitivity and specificity of 62% and 68%, respectively. Conclusion: In term growth restricted fetuses the degree of growth deficit from the optimal customized growth may be used to identify a subgroup of fetuses at high-risk for adverse outcomes.

Prediction of adverse perinatal outcome at term in small-for-gestational age fetuses: comparison of growth velocity vs. customized assessment.

Abstract Objective: To explore the ability of growth velocity and customized standards of fetal weight to predict adverse outcomes in small fetuses delivered at term. Methods: We evaluated a cohort of 86 consecutive singletons suspected to be small for gestational age during the third trimester (estimated fetal weight <10th centile), who had normal umbilical artery Doppler and ultimately delivered at term. Conditional growth velocity and customized fetal growth were compared for the prediction of adverse outcome. Results: Overall, customized growth assessment showed better sensitivity than growth velocity assessment (57.1% vs. 42.9% for a 10th centile cut-off) for the prediction of adverse outcome, but with comparable specificity. The odds of having an adverse outcome for women with a positive test compared with women with a negative test were 1.54 and 3.22 for the 10th centile growth velocity and customized definitions, respectively. The area under the curve for the prediction of adverse outcome was larger for customized than for growth velocity standards (0.65 vs. 0.59), albeit without statistical significance. Conclusions: Our study suggests that customized growth assessment may have better accuracy in predicting adverse perinatal outcome than growth velocity in small fetuses with normal umbilical Doppler delivered at term.

Evaluation of two doses of recombinant human luteinizing hormone supplementation in down-regulated women of advanced reproductive age undergoing follicular stimulation for IVF: a randomized clinical study

OBJECTIVES To evaluate the effects of mid-follicular recombinant human luteinizing hormone (rhLH) supplementation in down-regulated women of advanced reproductive age undergoing in vitro fertilization (IVF). STUDY DESIGN This was a prospective, randomized parallel-group study (allocation 1:1) including 187 normogonadotrophic infertile patients aged ≥ 35 years. Subcutaneous triptorelin was used for pituitary desensitization, and ovarian stimulation was achieved with recombinant human follicle-stimulating hormone (rhFSH) either alone (Group 1) or in combination with rhLH in one of two daily doses: 37.5 IU (Group 2) or 75 IU (Group 3). Ovarian stimulation characteristics and IVF outcome were evaluated. The main outcome was pregnancy rate. RESULTS A total of 62, 62 and 63 patients were randomized to groups 1, 2 and 3 respectively, and 56, 54 and 55 patients respectively were available for final analysis of the results. Follicular development and oocyte yield were significantly higher in group 1 patients compared with patients in groups 2 and 3. Oocyte maturity and number of oocytes fertilized were also higher in group 1 patients; this difference almost reached statistical significance. No significant difference in implantation and clinical pregnancy rates was found among the three treatment groups. CONCLUSIONS rhLH supplementation is not a useful tool for patients of advanced reproductive age in ovarian stimulation protocols using an appropriate gonadotrophin-releasing hormone agonist and a step-down regimen of rhFSH.

Human chorionic gonadotrophin stimulation test as a predictor of ovarian response and pregnancy in IVF cycles stimulated with GnRH agonist gonadotrophin treatment: a pilot study

BACKGROUND Recent evidence supports a specific and broad role of androgen produced by theca cells in reproductive physiology. This pilot study evaluated the usefulness of hCG theca stimulation test in predicting ovarian response and pregnancy. METHODS Prospective cohort study including 80 infertile women treated with IVF/ICSI. On Day 3 of the menstrual cycle preceding, the first IVF/ICSI cycle a blood sample was drawn to evaluate baseline FSH, estradiol (E(2)), 17-hydroxy-progesterone, androstenedione and testosterone levels. All women then received 250 µg recombinant hCG s.c. and underwent a second blood sampling 24 h after hCG injection to measurement steroid serum levels. RESULTS Percentage increment of E(2) but not its precursors was significantly higher in normo-responders and pregnancy cycles than in poor responders and non-pregnancy cycles (P = 0.03 and P = 0.02, respectively) diagnostic accuracy being 67 and 75%, respectively. The percentage increase in E(2) thus still fails in as many as 33 and 25% of patients in predicting ovarian response and pregnancy, respectively. In addition, E(2) concentrations are poorly reproducible and a wide range of variation in all serum steroids investigated-including E(2)-after hCG injection was observed. CONCLUSIONS The predictive power of the hCG test is based on E(2) but not androgen response to hCG injection. This test cannot be recommended in routine clinical practice because it is too laborious for screening purposes, shows great variability in the response obtained and its overall accuracy is not better than that reported for other available markers of ovarian reserve. The use of the currently available markers, antral follicle count and anti-Müllerian hormone, is therefore recommended.

P34.05: Customized standards of estimated fetal weight as predictor of adverse perinatal outcome

Methods: We measured biparietal diameter (BPD), femur length (FL), TC and AC in 57 women at 20 to 41 weeks of gestation. They had no fetal anomalies affecting fetal biometry. The equation between AC and TC was obtained by regression analysis. Then, we compared EFW calculated using mAC with that using cAC from the equation in fetuses with abdominal wall defect or ascites. Results: (1) We obtained the equation by regression analysis in fetuses without anomalies affecting AC. AC = 1.151 × TC + 1.984 (R2 = 0.869, P < 0.001) (2) In cases of fetal anomalies such as abdominal wall defect or ascites, EFW using cAC from the equation was more accurate than EFW using mAC. Conclusions: The ratio AC to TC is relatively constant regardless of gestational age beyond second trimester. cAC calculated from TC instead of mAC is more accurate to estimate fetal weight and may improve to detect abnormal fetal growth in fetuses who are affected by abdominal wall defect or ascites.

OP14.09: Perinatal and neurological outcomes in low birth fetuses with pathologic doppler study in middle cerebral artery

Methods: 137 second-trimester pregnancies (weeks 18 to 26) were included in this retrospective study. All patients were characterized by an abnormal uterine perfusion (mean pulsatility index of both uterine arteries > 1.4 and/or bilateral notching) at that time. A second Doppler examination was performed 4 weeks later and/or following clinical necessity. Perinatal outcome was analyzed regarding incidence of complications such as pre-eclampsia, hypertensive disorders, HELLP syndrome, IUGR, preterm delivery and perinatal mortality. Results: 35.7% of the patients showed a normalization of uterine perfusion between the two measurements (weeks 21 and 32). In patients with persistent abnormal uterine perfusion (64.3%) subsequent complications were significantly more common (22% vs. 60.5%, P < 0.001). This was mainly due to a significantly higher rate of pre-eclampsia (4.7% vs. 23.5%, P < 0.01), IUGR (13.3 vs. 42%, P < 0.01), and preterm delivery before 37 weeks of gestation (20% vs. 42%, P < 0.025). In those patients who still showed abnormal uterine perfusion at the third examination (32.5%) all complications besides preterm delivery before 34 weeks were significantly more common than in those with normalization at that point. Conclusions: The dynamic of a primarily abnormal uterine perfusion gives important prognostic information for the later course of pregnancy. Normalization of uterine perfusion is associated with a significantly lower risk of abnormal pregnancy outcome and thus represents a positive prognostic criterion. We conclude that in the case of an abnormal uterine perfusion in the second trimester a follow-up measurement is needed.

OC249: Predictive value of antenatal umbilical artery Doppler for adverse pregnancy outcome in small-for-gestational age babies according to customized birth weight centiles

A cohort was created of 7645 singleton pregnancieswithout congenital anomalies. Fetuses suspected antenatally ofbeing small for gestational age were referred for assessment byumbilical artery Doppler. The associations with adverse outcomewere assessed for small-for-gestational age babies who had normaland abnormal Doppler, compared withneonates whowerenotsmallfor gestational age. Perinatal outcome indicators were collected,including fetal distress requiring Cesarean section and neonatalmorbidity (neonatal intensive care

OP13.13: Customized centiles and perinatal morbidity

flow (ml/min) reduced with UtA PI growth, even not significantly. UtA flow per EFW did show a significant inverse correlation to gestational age, dropping from 780.6 ml/min/kg at 15 weeks to 138.1 at 35 weeks (5.6 fold) (p < 0.001). Conclusions: 1) UtA flow (ml/min) and mean velocity significantly increased across gestation in normal pregnancies, while UtA diameter showed a slight not significant increment; 2) UtA flow volume (ml/min) did not show a significant reduction in relation to UA PI increase; UtA flow per EFW significantly reduced along gestation.

OC89: First‐trimester maternal serum PAPP‐A and discrepancy between menstrual and ultrasonographic gestational age estimates in the prediction of fetal growth restriction

Objective: To examine the value of combining maternal history with cervical length and uterine artery Doppler at 22–24 weeks in the prediction of early preterm delivery. Methods: This was a prospective multicentre observational study in seven hospitals in London, UK. We used transvaginal sonography to measure cervical length and uterine artery pulsatility index (PI) at 22–24 weeks in singleton pregnancies. Logistic regression was used to determine the contribution of maternal characteristics, previous obstetric history, cervical length and uterine artery PI in the prediction of delivery before 33 weeks. Results: 32,150 women were recruited and 1,373 women (4.3%) were lost to follow-up. Delivery before 33 weeks occurred in 439 (1.4%) women, including spontaneous or iatrogenic delivery of stillbirths in 52 (0.2%) cases, spontaneous delivery of live births in 238 (0.8%) and iatrogenic delivery of live births in 149 (0.5%). For a 5% false positive rate, the detection rate of spontaneous early delivery was 30% for maternal factors and this was improved to 50% by combining maternal factors with cervical length. Similarly, for iatrogenic delivery and fetal death, the detection rate was improved from 44% and 33% respectively from maternal history alone to 81% and 67% respectively with the addition of uterine artery PI. Conclusion: The combination of maternal history, cervical length and uterine artery PI at 22–24 weeks can identify a high proportion of women that subsequently deliver before 33 weeks.