OP23.02: Amniotic fluid erythropoietin like matter of distinction between IUGR and constitutionally small fetuses

Abstract

To determine the possibilities of analysis of erythropoietin (EPO) in amniotic fluid as a parameter independent of gestational age and subjective interpretations upon making a distinction between IUGR and constitutionally small fetuses. Prospective clinical study was conducted on 38 pregnancies with fetuses small for gestational age. Small for gestational age fetuses (SGA) have been defined as both estimated fetal weight and neonatal body weight beyond 10th percentile for our population. The study group was divided into two subgroups: constitutionally small fetuses, n = 16 (42.11%) and growth restricted fetuses, n = 22 (57.89%). The diagnosis of both, constitutionally small and growth restricted fetuses, were based upon standard criteria (fetal biometry as well as AFI and Doppler evaluation). Amniotic fluid samples were collected in all pregnancies in order to evaluate EPO levels, by amniocenthesis for determination of lung maturity, maximum 48 hours before delivery EPO concentration was higher in growth restricted fetuses compared to constitutionally small fetuses showing high statistical significance (p < 0.01). ROC analysis for EPO values comparing growth restricted fetuses and constitutionally small fetuses has the best result at the level of 9.8 IU/L. This cut-off point has sensitivity of 81%, specificity of 80%, PPV 81.2% and NPV 88.4%. Neonates with EPO concentrations above 9.8 IU/l were more frequent admitted to the NICU and concentrations of EPO showed statistical significance (p < 0.05) comparing to those without admittance at NICU. There is a difference in amniotic fluid EPO concentrations between growth restricted and constitutionally small fetuses. Concerning the fact that EPO production is independent of gestational age, EPO concentrations may be used as a distinction between the pathologically and physiologically small for gestational age fetuses when amniocentesis is done for the detection of fetal lung maturity or rapid karyotypisation