Abstract
Managing fetal growth restriction (FGR) with umbilical artery (UA) Doppler improves outcomes. Recommendations are to sample the UA in a free loop of the mid-segment, but no guidelines exist for sampling both (paired) UA in FGR. We previously reported discrepant paired UA in a FGR cohort, but a paucity of data to support the approach makes clinical significance unclear. We hypothesized that patients with discrepant paired UAs would have biometric trends similar to those with both UAs abnormal. In this prospective observational study, 73 patients with estimated fetal weights (EFW) <10th%, were followed serially between 24 and 38 weeks gestational age (GA). Doppler and standard biometry including femur length (FL), abdominal circumference (AC), head circumference (HC), and biparietal diameter (BPD) were obtained. After delivery, patients were assigned to 1 of 3 groups: Group 1: both UA normal at last exam (n=49); Group 2: multiple exams with discrepancies (n=13); Group 3: both UAs abnormal at last exam (n=8). Biometry values were plotted over GA. Differences in slope or average difference in y-values between groups were analyzed with a linear mixed model ANOVA in SAS. Available outcome data: birth weight percentile (BW%), GA at delivery, and Ponderal index (PI) were compared across UA groups with one-way ANOVA. There is a linear and parallel increase of all biometric measurements across GA. Table 1 shows biometric values among groups. AC and FL are smaller in groups 2 and 3 compared to group 1, but no difference exists between groups 2 and 3. EFW is lower in group 3, compared to group 1. HC is smaller in group 3 compared to groups 1 and 2. BPD is similar between groups. BW% is lower in group 3 compared to group 1 and PI is trending towards significance (Fig 1). The similar and significant decrease in FL and AC between discrepant (group 2) and abnormal UA Doppler (group 3) groups suggests that an abnormality in at least one UA may be an effective marker of FGR placental pathology. HC and BPD did not demonstrate similar findings, which is not surprising given brain sparing associated with FGR, and likely explains the lack of EFW significance. While outcome showed significant differences in BW%, additional data are needed to improve the power of the study. Our results suggest pathology with one abnormal UA. (Funded by The Perelman IUGR Study).View Large Image Figure ViewerDownload Hi-res image Download (PPT)
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