EP13.22: Doppler ultrasound indices and composite adverse perinatal outcome of early‐ and late‐onset FGR of estimated fetal weight < 3rd centile

Pregnancies complicated with fetal growth restriction (FGR) have increased risk of short- and long-term neonatal morbidities. To determine altered Doppler ultrasound findings that are associated with composite adverse perinatal outcome (CAPO) of early- and late-onset FGR with estimated fetal weight (EFW) < 3rd centile. A multicentre retrospective study was conducted on women with FGR of EFW < 3rd centile by Hadlock standard. Ultrasound findings were obtained typically by one week before birth. As Doppler indices change with gestational age, values were expressed into z-scores. CAPO was defined as the occurrence of at least two of 5-min Apgar score < 7, umbilical artery (UA) pH < 7.10, neonatal care unit (NICU) admission, respiratory distress, neonatal enterocolitis, intraventricular hemorrhage, sepsis, perinatal loss, and emergency Caesarean section for fetal distress. Logistic regression analysis was used to determine the association between Doppler ultrasound variables and CAPO. In early onset, 114 singleton pregnancies were included. On multivariable logistic regression analysis, z-score of cerebroplacental ratios (CPR) (p = 0.021) was associated independently with CAPO. Z-score of UA pulsatility index (PI) and middle cerebral artery (MCA) PI were not significant. In late onset, 86 singleton pregnancies were included. Z-score of MCA PI (p = 0.021) and of CPR (p = 0.008) were associated independently with CAPO. When compared between groups with CPR < 5th centile and those without. In the group with CPR < 5th centile, emergency Caesarean section for fetal distress was significantly high and UA pH was low at early-onset FGR. In late-onset FGR, low UA pH, stay in NICU, and pre-eclampsia in pregnancy were increased. In FGR of EFW < 3rd centile, z-score of CPR is associated independently with CAPO in early-onset FGR. Along with z-score of CPR, z-score of MCA PI is also associated independently with CAPO in late-onset FGR.