E. Meler

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.

Longitudinal changes in uterine, umbilical and fetal cerebral Doppler indices in late‐onset small‐for‐gestational age fetuses

To determine the longitudinal trends and rates of conversion of normal to abnormal uterine (UtA), umbilical (UA) and middle cerebral artery (MCA) Doppler velocimetry throughout the third trimester in late‐onset small‐for‐gestational‐age (SGA) fetuses.

Customised birthweight standards accurately predict perinatal morbidity

Objective: Fetal growth restriction is associated with adverse perinatal outcome but is often not recognised antenatally, and low birthweight centiles based on population norms are used as a proxy instead. This study compared the association between neonatal morbidity and fetal growth status at birth as determined by customised birthweight centiles and currently used centiles based on population standards. Design: Retrospective cohort study. Setting: Referral hospital, Barcelona, Spain. Patients: A cohort of 13 661 non-malformed singleton deliveries. Interventions: Both population-based and customised standards for birth weight were applied to the study cohort. Customised weight centiles were calculated by adjusting for maternal height, booking weight, parity, ethnic origin, gestational age at delivery and fetal sex. Main outcome measures: Newborn morbidity and perinatal death. Results: The association between smallness for gestational age (SGA) and perinatal morbidity was stronger when birthweight limits were customised, and resulted in an additional 4.1% (n = 565) neonates being classified as SGA. Compared with non-SGA neonates, this newly identified group had an increased risk of perinatal mortality (OR 3.2; 95% CI 1.6 to 6.2), neurological morbidity (OR 3.2; 95% CI 1.7 to 6.1) and non-neurological morbidity (OR 8; 95% CI 4.8 to 13.6). Conclusion: Customised standards improve the prediction of adverse neonatal outcome. The association between SGA and adverse outcome is independent of the gestational age at delivery.

Performance of a first-trimester screening of preeclampsia in a routine care low-risk setting

OBJECTIVE We sought to evaluate the effectiveness of an integrated first-trimester screening test to predict preeclampsia (PE). STUDY DESIGN A prospective cohort of singleton pregnancies underwent routine first-trimester screening from 2009 through 2011 (n = 5759). A logistic regression-based predictive model for early- and late-onset PE was constructed based on: maternal characteristics; levels of pregnancy-associated plasma protein-A and free β-human chorionic gonadotropin at 8-12 weeks; and blood pressure and uterine artery Doppler at 11.0-13.6 weeks. RESULTS Of the 5170 enrolled participants, 136 (2.6%) developed PE (early PE: 26 [0.5%]; late PE: 110 [2.1%]). At 5% and 10% false-positive rates, detection rates were 69.2% and 80.8% for early PE (area under the curve, 0.95; 95% confidence interval, 0.94-0.98) and 29.4% and 39.6% for late PE (area under the curve, 0.71; 95% confidence interval, 0.66-0.76), respectively. CONCLUSION First-trimester screening combining maternal factors with uterine artery Doppler, blood pressure, and pregnancy-associated plasma protein-A is useful to predict PE in a routine care setting.

Cerebral blood perfusion and neurobehavioral performance in full-term small-for-gestational-age fetuses

OBJECTIVE The purpose of this study was to evaluate changes in cerebral blood perfusion and middle cerebral artery (MCA) Doppler in full-term small-for-gestational-age fetuses (SGA) and to explore their association with neonatal neurobehavioral performance. STUDY DESIGN Frontal brain perfusion that was measured by fractional moving blood volume (FMBV) and MCA Doppler pulsatility index were assessed in 60 SGA fetuses with normal umbilical artery Doppler results that were matched with adequate-for-gestational-age fetuses. Neonates were evaluated with the Neonatal-Behavioral-Assessment-Scale (NBAS). RESULTS The proportion of SGA fetuses with increased FMBV (35% vs 5%; P < .001) and decreased MCA Doppler pulsatility index (15% vs 1.7%; P < .01) was significantly higher. SGA fetuses showed poorer NBAS scores in all areas. Increased FMBV identified SGA fetuses with the highest risks of abnormal NBAS in social-interactive (odds ratio, 7.8), attention (odds ratio, 22.8), and state-organization (odds ratio, 25.0). Abnormal MCA Doppler identified SGA with abnormal scores in motor area (odds ratio, 10.7). CONCLUSION Increased brain blood perfusion discriminates SGA fetuses that are at risk for abnormal neurobehavior.

Middle versus anterior cerebral artery Doppler for the prediction of perinatal outcome and neonatal neurobehavior in term small‐for‐gestational‐age fetuses with normal umbilical artery Doppler

To evaluate whether anterior cerebral artery (ACA) Doppler ultrasonography is superior to middle cerebral artery (MCA) Doppler in the prediction of perinatal outcome and neonatal neurobehavior in term small‐for‐gestational‐age (SGA) fetuses with normal umbilical artery (UA) Doppler.

First-trimester screening for early and late small-for-gestational-age neonates using maternal serum biochemistry, blood pressure and uterine artery Doppler.

To assess the effectiveness of first‐trimester screening for early and late small‐for‐gestational‐age (SGA) neonates using maternal serum biochemistry, blood pressure and uterine artery Doppler.

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.

Learning curve for Doppler measurement of fetal modified myocardial performance index

To assess the learning curve for measurement of the fetal modified myocardial performance index (MPI).