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Observational Study
. 2023 Feb;44(1):56-67.
doi: 10.1055/a-1511-8293. Epub 2021 Nov 12.

Longitudinal Doppler Assessments in Late Preterm Fetal Growth Restriction

Bronacha Mylrea-Foley  1   2 , Hans Wolf  3 , Tamara Stampalija  4   5 , Christoph Lees  1   2   6 ; Truffle-2 Group; TRUFFLE 2 Authors:; B Arabin  7 , A Berger  8 , E Bergman  9 , A Bhide  10 , C M Bilardo  11 , A C Breeze  12 , J Brodszki  13 , P Calda  14 , I Cetin  15 , E Cesari  15 , J Derks  16 , C Ebbing  17 , E Ferrazzi  18 , W Ganzevoort  3 , T Frusca  19 , S J Gordijn  20 , W Gyselaers  21 , K Hecher  22 , P Klaritsch  23 , L Krofta  24 , P Lindgren  25 , S M Lobmaier  26 , N Marlow  27 , G M Maruotti  28 , F Mecacci  29 , K Myklestad  30 , R Napolitano  27   31 , F Prefumo  32 , L Raio  33 , J Richter  6 , R K Sande  34 , J Thornton  35 , H Valensise  36 , G H A Visser  17 , L Wee  37 ; TRUFFLE-2 GROUP AND COLLABORATING AUTHORS; C. Brezinka, Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria; D. Casagrandi, University College London Hospitals NHS Foundation Trust, London, UK; A. Cerny, Department of Obstetrics and Gynaecology, GeneralUniversity Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic; A. Dall’Asta, Department of Obstetrics and Gynecology, University of Parma, Parma, Italy; R. DeVlieger, Department of Gynecology and Obstetrics, UZ Leuven, Leuven and Department of Regeneration and Development, KU Leuven, Leuven, Belgium; J. Duvekot, Department of Obstetrics and Gynecology, Erasmus Academic Centre Rotterdam, Rotterdam, The Netherlands; T. M. Eggebo, St Olav’s Hospital, Trondheim, Norway; I. Fantasia, Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy; F. Ferrari, Obstetrics & Gynecology, Policlinico University Hospital of Modena, Modena, Italy; N. Fratelli, Department of Obstetrics and Gynecology, ASST Spedali Civili di Brescia and University of Brescia, Brescia, Italy; T. Ghi, Department of Obstetrics and Gynecology, University of Parma, Parma, Italy; O. Graupner, Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany; P. Greimel, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria; C. Hofstaetter, Department of Obstetrics & Gynecology, University Hospital of Bern, Bern, Switzerland; D. Lo Presti, Department of Surgery, Division of Obstetrics and Gynecology, Tor Vergata University, Policlinico Casilino Hospital, Rome, Italy; M. Georg, Helsinki University Central Hospital, Helsinki, Finland; F. Macsali, Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway; K. Marsal, Department of Obstetrics and Gynecology, Lund University, Skåne University Hospital, Lund, Sweden; P. Martinelli, Department of Neurosciences, Reproductive and Dentistry Sciences, University of Naples ‘Federico II’, Naples, Italy; E. Ostermayer, Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany; A. Papageorghiou, Fetal Medicine Unit, St George’s University Hospitals NHS Foundation Trust and Molecular & Clinical Sciences Research Institute, St George’s, University of London, London, UK; R. Peasley, Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK; A. Ramoni, Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria; L. Sarno, Department of Neurosciences, Reproductive and Dentistry Sciences, University of Naples ‘Federico II’, Naples, Italy; L. Seikku, Helsinki University Central Hospital, Helsinki, Finland; S. Simeone, Department of Health Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy; B. Thilaganathan, Fetal Medicine Unit, St George’s University Hospitals NHS Foundation Trust and Molecular & Clinical Sciences Research Institute, St George’s, University of London, London, UK; G. Tiralongo, Department of Surgery, Division of Obstetrics and Gynecology, Tor Vergata University, Policlinico Casilino Hospital, Rome, Italy; A. Valcamonico, Department of Obstetrics and Gynecology, ASST Spedali Civili di Brescia and University of Brescia, Brescia, Italy; C. Van Holsbeke, Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium; A. Vietheer, Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
Affiliations
Free article
Observational Study

Longitudinal Doppler Assessments in Late Preterm Fetal Growth Restriction

Bronacha Mylrea-Foley et al. Ultraschall Med. 2023 Feb.
Free article

Abstract
in English, German

Purpose: To assess the longitudinal variation of the ratio of umbilical and cerebral artery pulsatility index (UCR) in late preterm fetal growth restriction (FGR).

Materials and methods: A prospective European multicenter observational study included women with a singleton pregnancy, 32+ 0-36+ 6, at risk of FGR (estimated fetal weight [EFW] or abdominal circumference [AC] < 10th percentile, abnormal arterial Doppler or fall in AC from 20-week scan of > 40 percentile points). The primary outcome was a composite of abnormal condition at birth or major neonatal morbidity. UCR was categorized as normal (< 0.9) or abnormal (≥ 0.9). UCR was assessed by gestational age at measurement interval to delivery, and by individual linear regression coefficient in women with two or more measurements.

Results: 856 women had 2770 measurements; 696 (81 %) had more than one measurement (median 3 (IQR 2-4). At inclusion, 63 (7 %) a UCR ≥ 0.9. These delivered earlier and had a lower birth weight and higher incidence of adverse outcome (30 % vs. 9 %, relative risk 3.2; 95 %CI 2.1-5.0) than women with a normal UCR at inclusion. Repeated measurements after an abnormal UCR at inclusion were abnormal again in 67 % (95 %CI 55-80), but after a normal UCR the chance of finding an abnormal UCR was 6 % (95 %CI 5-7 %). The risk of composite adverse outcome was similar using the first or subsequent UCR values.

Conclusion: An abnormal UCR is likely to be abnormal again at a later measurement, while after a normal UCR the chance of an abnormal UCR is 5-7 % when repeated weekly. Repeated measurements do not predict outcome better than the first measurement, most likely due to the most compromised fetuses being delivered after an abnormal UCR.

ZIEL: Beurteilung der longitudinalen Variation der umbilikozerebralen Ratio (UCR) der Pulsatilitätsindizes bei später fetaler Wachstumsrestriktion (FGR).

Material und methoden: Eine prospektive europäische multizentrische Beobachtungsstudie schloss Frauen mit Einlingsschwangerschaft (32+ 0–36+ 6) und Risiko für FGR ein (geschätztes fetales Gewicht (EFW) oder Abdomenumfang (AU) < 10. Perzentile, abnormaler arterieller Doppler oder Absinken der AU-Perzentile um > 40 Punkte im US in der 20. SSW). Der primäre Outcome war kombiniert aus auffälligen Geburtsparametern oder schwerer neonataler Morbidität. Die UCR wurde als normal (< 0,9) oder abnormal (≥ 0,9) eingestuft. Die UCR wurde im Messintervall bis zur Entbindung mittels SSW und mittels individuellen linearen Regressionskoeffizienten bei Frauen mit 2 oder mehr Messungen bewertet.

Ergebnisse: 856 Frauen hatten 2770 Messungen; 696 (81 %) hatten mehr als eine Messung (Median 3, IQR 2–4). Bei Einschluss hatten 63 (7 %) eine UCR ≥ 0,9. Diese entbanden früher und hatten ein niedrigeres Geburtsgewicht und eine höhere Inzidenz für einen unerwünschten Outcome (30 % vs. 9 %, relatives Risiko 3,2; 95 %-KI 2,1–5,0) im Vergleich zu Frauen mit normaler UCR bei Einschluss. Wiederholte Messungen nach abnormaler UCR bei Einschluss waren in 67 % (95 %-KI 55–80) erneut abnormal, aber nach einer normalen UCR betrug die Wahrscheinlichkeit, eine abnormale UCR zu finden, 6 % (95 %-KI 5–7 %). Das Risiko für einen kombinierten unerwünschten Outcome war ähnlich, wenn man den ersten oder den nachfolgenden UCR-Wert verwendete.

Schlussfolgerung: Eine abnormale UCR ist wahrscheinlich bei einer späteren Messung wieder abnormal, während nach einer normalen UCR die Wahrscheinlichkeit einer abnormalen UCR bei wöchentlicher Wiederholung 5–7 % beträgt. Wiederholte Messungen sagen das Ergebnis nicht besser voraus als die erste Messung, was höchstwahrscheinlich darauf zurückzuführen ist, dass die am stärksten gefährdeten Föten nach einer abnormalen UCR entbunden werden.

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The authors declare that they have no conflict of interest.

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