Objective: Pregnancies complicated by lateonset fetal growth restriction (FGR) are at increased risk of short and longterm 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 lateonset FGR and adverse perinatal outcome, and to determine their predictive accuracy. Methods: This was a prospective study of consecutive singleton pregnancies complicated by lateonset FGR. Lateonset FGR was defined as estimated fetal weight (EFW) or abdominal circumference (AC) < 3rd centile, or EFW or AC < 10th centile and umbilical artery (UA) pulsatility index (PI) > 95th centile or cerebroplacental ratio (CPR) < 5th centile, diagnosed after 32 weeks. EFW, uterine artery PI, UAPI, 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 Zscores for gestational age. Composite adverse perinatal outcome was defined as the occurrence of at least one of emergency Cesarean section for fetal distress, 5min 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 receiveroperatingcharacteristics (ROC)curve analysis was used to determine their predictive accuracy. Results: In total, 243 consecutive singleton pregnancies complicated by lateonset 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 Zscore (2.23 ± 1.34 vs 1.88 ± 0.89, P = 0.02) was higher, while Zscores of UVBF/AC (−1.93 ± 0.88 vs −0.89 ± 0.94, P ≤ 0.0001), MCAPI (−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, Zscores of mean uterine artery PI (P = 0.04), CPR (P = 0.002) and UVBF/AC (P = 0.001) were associated independently with composite adverse perinatal outcome. UVBF/AC Zscore had an area under the ROC curve (AUC) of 0.723 (95% CI, 0.64–0.80) for composite adverse perinatal outcome, demonstrating better accuracy than that of mean uterine artery PI Zscore (AUC, 0.593; 95% CI, 0.50–0.69) and CPR Zscore (AUC, 0.615; 95% CI, 0.52–0.71). A multiparametric prediction model including Zscores of MCAPI, uterine artery PI and UVBF/AC had an AUC of 0.745 (95% CI, 0.66–0.83) for the prediction of composite adverse perinatal outcome. Conclusion: While CPR and uterine artery PI assessed at the time of diagnosis are associated independently with composite adverse perinatal outcome in pregnancies complicated by lateonset FGR, their diagnostic performance for composite adverse perinatal outcome is low. UVBF/AC showed better accuracy for prediction of composite adverse perinatal outcome, although its usefulness in clinical practice as a standalone predictor of adverse pregnancy outcome requires further research. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Role of Doppler ultrasound at time of diagnosis of lateonset fetal growth restriction in predicting adverse perinatal outcome: prospective cohort study
D'Antonio F.^{ Ultimo}
20200101
Abstract
Objective: Pregnancies complicated by lateonset fetal growth restriction (FGR) are at increased risk of short and longterm 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 lateonset FGR and adverse perinatal outcome, and to determine their predictive accuracy. Methods: This was a prospective study of consecutive singleton pregnancies complicated by lateonset FGR. Lateonset FGR was defined as estimated fetal weight (EFW) or abdominal circumference (AC) < 3rd centile, or EFW or AC < 10th centile and umbilical artery (UA) pulsatility index (PI) > 95th centile or cerebroplacental ratio (CPR) < 5th centile, diagnosed after 32 weeks. EFW, uterine artery PI, UAPI, 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 Zscores for gestational age. Composite adverse perinatal outcome was defined as the occurrence of at least one of emergency Cesarean section for fetal distress, 5min 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 receiveroperatingcharacteristics (ROC)curve analysis was used to determine their predictive accuracy. Results: In total, 243 consecutive singleton pregnancies complicated by lateonset 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 Zscore (2.23 ± 1.34 vs 1.88 ± 0.89, P = 0.02) was higher, while Zscores of UVBF/AC (−1.93 ± 0.88 vs −0.89 ± 0.94, P ≤ 0.0001), MCAPI (−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, Zscores of mean uterine artery PI (P = 0.04), CPR (P = 0.002) and UVBF/AC (P = 0.001) were associated independently with composite adverse perinatal outcome. UVBF/AC Zscore had an area under the ROC curve (AUC) of 0.723 (95% CI, 0.64–0.80) for composite adverse perinatal outcome, demonstrating better accuracy than that of mean uterine artery PI Zscore (AUC, 0.593; 95% CI, 0.50–0.69) and CPR Zscore (AUC, 0.615; 95% CI, 0.52–0.71). A multiparametric prediction model including Zscores of MCAPI, uterine artery PI and UVBF/AC had an AUC of 0.745 (95% CI, 0.66–0.83) for the prediction of composite adverse perinatal outcome. Conclusion: While CPR and uterine artery PI assessed at the time of diagnosis are associated independently with composite adverse perinatal outcome in pregnancies complicated by lateonset FGR, their diagnostic performance for composite adverse perinatal outcome is low. UVBF/AC showed better accuracy for prediction of composite adverse perinatal outcome, although its usefulness in clinical practice as a standalone predictor of adverse pregnancy outcome requires further research. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.File  Dimensione  Formato  

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