Isabella Crippa

Can adverse neonatal outcome be predicted in late preterm or term fetal growth restriction

To identify independent predictors of adverse neonatal outcome in cases of fetal growth restriction (FGR) at ≥ 34 weeks.

Prediction of superimposed preeclampsia using uterine artery Doppler velocimetry in women with chronic hypertension.

To assess the role of uterine artery (UtA) Doppler to predict superimposed preeclampsia in women with chronic hypertension.

P32.05: Uterine artery Doppler in a risk population: What's its role in the prediction of severe pregnancy complications?

Objective: The aim of this study was to evaluate the efficacy of uterine artery Doppler velocimetry in predicting placenta previa-accreta. Methods: Clinical records of all deliveries between April 1991 and June 2007 were retrospectively analyzed. Cases with small for gestational age, pregnancy-induced hypertension, multiple pregnancies, fetal anomalies, chromosomal abnormalities, and maternal medical illnesses such as cardiovascular disease, renal disease or diabetes mellitus were excluded. Out of 10,977 total cases evaluated, 173 had placenta previa without accreta (PP) and 28 placenta previa with accreta (PPA), diagnosed by histological confirmation. All patients underwent uterine artery Doppler flow velocimetry to measure the mean resistance index (RI) at third trimester, and age, parity, previous abortion history, previous cesarean section history, gestational age at delivery, child sex and birth weight were reviewed. Multiple logistic regression was performed to adjust for potentially confounding variables. Results: Statistically significant differences were found in age, parity, previous abortion, previous cesarean section, gestational age at delivery, and birth weight (P < 0.001, respectively) between the normal group (n = 10,776) and the placenta previa group (n = 201, PP + PPA). Uterine artery Doppler mean RI and sex were similar in both groups (P > 0.05). In placenta previa group, no difference was observed in all variables except uterine artery Doppler mean RI between PP and PPA. In cases of uterine artery Doppler mean RI lesser than 0.40, women who had placenta previa were at increased risk of having placenta accreta (odds ratio [OR] 3.39; 95% confidence interval [CI] 1.41, 8.16). Conclusions: This study shows that uterine artery Doppler RI is reduced in PPA compared with PP. Low uterine artery Doppler RI is independent risk factor of placenta accreta in placenta previa patients.

O6. Uterine artery Doppler in a risk population: What’s its role in the prediction of small for gestational age fetuses?

Objective: The aim of this retrospective study was to assess the role of uterine artery (UtA) Doppler velocimetry in the prediction of small for gestational age (SGA) fetuses in a high risk population. Methods: A population of 145 singleton high risk pregnancies was evaluated with serial UtA Doppler performed within 23 weeks (I UtADoppler) and between 23 and 30 weeks’ gestation (II UtA Doppler). Risk population was composed by women with chronic hypertension or with a previous pregnancy complicated by one of the following: preeclampsia, stillbirth, abruptio placentae, small for gestational age newborns. The association between an abnormal UtA velocimetry (Resistance Index > 0.58 and/or bilateral notch) and the probability to develop SGA fetuses was analysed. SGA fetuses were diagnosed on the base of ultrasonographic measurement of abdominal circumference below the 10 centile. Therapy with low-dose aspirin and/or Low Weight Molecular Heparin was prescribed according with a clinical protocol. Results: Gestational age at delivery, mean birth weight, abnormal UtA Doppler and Umbilical artery Doppler were significantly different between SGA fetuses and not SGA fetuses (Table 1). Particularly 30% of SGA fetuses with an abnormal UtA Doppler had also an abnormal Umbilical artery Doppler (defined as a Pulsatility Index >95 centile). Logistic regression analysis showed that only the abnormal UtA Doppler test performed between 23 and 30 weeks’ gestation independently correlated with SGA fetuses, otherwise ASA was a significant protective factor for SGA fetuses (Table 2). Persistence of abnormal UtA Doppler was associated with a statistically higher rate of SGA. Conclusion: An abnormal UtA Doppler in the late second or early third trimester remained the variable significantly related with SGA fetuses; therefore UtA Doppler evaluation between 23 and 30 weeks could be useful for the management of high risk population. ASA was a significant protective factor for intrauterine growth.

OP14.14: Small for gestational age fetuses: Does presence of preeclampsia affect neonatal outcome?

Objectives: To evaluate the independent and combined contribution to short-term predictive value for mortality in severe IUGR of clinically used and recently described cardiovascular Doppler parameters. Methods: Umbilical artery, middle cerebral artery, ductus venosus (DV), aortic isthmus flow index and modified-myocardial performance index (Mod-MPI) were measured in a cohort of 97 preterm IUGR fetuses. Logistic regression was performed to select those variables that were independently associated to perinatal mortality, and an algorithm to estimate probabilities of death was constructed including the best combination of parameters. Results: A combination of gestational age (below or above 28 weeks), DV atrial flow (positive or absent-reverse) and ModMPI (normal or above 95th percentile) had the highest predictive value for perinatal mortality in IUGR cases. An algorithm including these 3 parameters had a better predictive accuracy than any single parameter. The risk for death below and above 28 weeks respectively was: normal DV and Mod-MPI, 18% and 0.1%; either abnormal, 70–73% and 6–7%; both abnormal, 97% and 45%. Conclusions: The use of composite cardiovascular Doppler scores may help to refine considerably the short-term prediction of perinatal mortality at different gestational ages in severe IUGR fetuses.