P05.03: Longitudinal antenatal testing alterations in severe IUGR fetuses

Abstract

Objective: To assess the longitudinal changes in Doppler velocimetry, FHR tracing and BPP in compromised IUGR fetuses. Methods: A prospective longitudinal study of 186 IUGR fetuses. All fetuses were enrolled in the study in the moment abdominal circumference was <10 percentile, plotted on the population growth curve. In all fetuses a daily FHR tracing, Doppler velocimetry twice weekly has been performed to assess the umbelical artery (UA), middle cerebral artery (MCA), ductus venosus (DV) and umbilical vein (UV) blood flow. The BPP and Amniotic fluid index was evaluated twice weekly. Results: Of 186 fetuses enrolled in the study 86 did not showed Doppler alteration and were not enrolled in the study. Gestational age at time of admission ranged from 19 to 39 weeks of gestation. 100 IUGR fetuses showed Doppler velocimetry alteration in the moment or after the enrollment. In all fetuses the first antenatal testing to show alteration was increased resistance of the UA (100%); UA AEDF (52%), UA RF (26%); brain sparing effect in the MCA (38%); abnormality in the DV (absent or reversed diastolic flow) and UV pulsations (20%). BPP and FHR tracing was abnormal in 30% of the fetuses and in all of them these changes occurred after Doppler velocimetry alterations with a mean time of 3.8 days. AFI was below the normal ranges in 42% of fetuses. Conclusions: Severe IUGR fetuses show a specific temporal sequence antenatal testing alterations consisting in Doppler velocimetry alterations FHR tracing become abnormal too late, and are the last changes seen in IUGR fetuses as well as the BPP and AFI.