THU0285 UMBILICAL ARTERIAL DOPPLER ULTRASONOGRAPHY PREDICTS LATE PREGNANCY OUTCOMES IN PATIENTS WITH LUPUS NEPHRITIS: A MULTICENTER STUDY FROM SOUTHERN CHINA

Abstract

Background Compared with the general population, patients with lupus nephritis (LN) are still at high risk of adverse pregnancy outcomes (APOs). Umbilical artery is the last vessel upstream of the placenta and is particularly important for placental perfusion and foetal development. Increased umbilical artery resistance could be traced by Doppler velocimetry, which is frequently related to pre-eclampsia, intrauterine growth restriction (IUGR), and foetal distress. Umbilical artery Doppler is used as a screening tool for placenta-related diseases in the general population. However, the predictive value in complications of LN pregnancies has not been widely assessed. Objectives To investigate the fetal adverse pregnancy outcomes (APOs) and the predictive value of umbilical arterial Doppler ultrasonography in the third trimester in pregnant women with LN. Methods A retrospective cohort study enrolling 203 LN patients with pregnancies from 2007 to 2017 from three centers was performed. These patients received umbilical arterial Doppler ultrasound examination during 28-34 gestational weeks. Doppler velocity waveforms of the umbilical arteries were assessed with resistance index (RI), systolic/diastolic ratio (S/D) and pulsatility index (PI). Results Fetal APOs occurred in over half of the patients (103/203, 50.7%). Sixty-six pregnancies (66/203, 32.5%) ended with preterm births. The incidence rate of IUGR was 18.2% (37/203). Fetal distress was noted in 23 pregnancies (23/203, 11.3%). All the Doppler parameters were higher in patients with IUGR, fetal distress and composite APOs than in patients without any APOs. Patients with IUGR and fetal distress had significantly higher values of PI, RI, and S/D. It was noted that PI, RI and S/D was higher in patients with premature delivery than those with full-term delivery. However, only the difference of RI and S/D reached statistical significance. RI indicated the highest risk of IUGR and composite APOs. The cut-off values were 0.66 and 0.67, respectively. Sensitivities were 51.4% and 33.7%, and specificities were 87.4% and 92.1%. S/D was also a best predictor for IUGR, with the optimal cut-off value of 2.88. Sensitivity and specificity were comparable with RI. PI over 0.84 was an ideal indicator for fetal distress with an optimal combination of sensitivity (89.5%) and specificity (51.6%). Conclusion Fetal complications were frequent in patients with LN. Umbilical arterial Doppler ultrasonography was a useful measure to predict late IUGR, fetal distress, and the composite APOs. Acknowledgement No Disclosure of Interests None declared