UOG Journal Club: Optimal risk assessment of small-for-gestational-age fetuses and changes in fetal Doppler indices as markers of failure to reach growth potential
The document summarizes two articles from the March 2014 issue of the Ultrasound in Obstetrics and Gynecology journal club. The first article compares the performance of traditional fetal growth charts versus a probabilistic model using biometry at 31-34 weeks to screen for small-for-gestational age fetuses in low-risk pregnancies. The probabilistic model had slightly better accuracy and allowed incorporation of maternal factors. The second article found that appropriate for gestational age fetuses in lower birth weight quartiles exhibited Doppler changes suggesting placental insufficiency and failure to reach growth potential, challenging the view that only small fetuses face these risks.
Growth charts in Neonates- Preterm and termSujit Shrestha
Growth charts in Newborn, Preterm and term neonates. All historically used charts in NICU are discussed here.
Presented by Dr Sujit, in Sir Ganga Ram Hospital
Comparison of Various Clinical Methods of Birth Weight Estimation in Term Pre...CrimsonPublishers-PRM
Comparison of Various Clinical Methods of Birth Weight Estimation in Term Pregnancy by Darshit G Prajapati in Perceptions in Reproductive Medicine_Crimson Publishers
Comparison of Various Clinical Methods of Birth Weight Estimation in Term Pre...CrimsonPublishers-PRM
Comparison of Various Clinical Methods of Birth Weight Estimation in Term Pregnancy by Darshit G Prajapati in Perceptions in Reproductive Medicine_Crimson Publishers
Growth charts in Neonates- Preterm and termSujit Shrestha
Growth charts in Newborn, Preterm and term neonates. All historically used charts in NICU are discussed here.
Presented by Dr Sujit, in Sir Ganga Ram Hospital
Comparison of Various Clinical Methods of Birth Weight Estimation in Term Pre...CrimsonPublishers-PRM
Comparison of Various Clinical Methods of Birth Weight Estimation in Term Pregnancy by Darshit G Prajapati in Perceptions in Reproductive Medicine_Crimson Publishers
Comparison of Various Clinical Methods of Birth Weight Estimation in Term Pre...CrimsonPublishers-PRM
Comparison of Various Clinical Methods of Birth Weight Estimation in Term Pregnancy by Darshit G Prajapati in Perceptions in Reproductive Medicine_Crimson Publishers
Aleitamento materno e adiposidade adultaLaped Ufrn
Aleitamento materno e adiposidade adulta (JPed 2014) - Artigo apresentado em Reunião Científica da Liga Acadêmica de Pediatria da UFRN - LAPED UFRN - Natal - RN - Brasil.
the objective is to clarify the problem of recurrent implantation failure , regarding the definition, the caused, diagnosis, and management in cases of IVF
Ahmed Walid Anwar Morad, Professor Obstetrics and Gynecology
Optional procedures alongside the standard IVF protocol to increase the chance of a live birth.
Poor neonatal acid–base status in term fetuses with low cerebroplacental ratio
J. Morales-Roselló, A. Khalil, M. Morlando, A. Bhide, A. Papageorghiou and B. Thilaganathan
Volume 45, Issue 2, Date: February (pages 156–161)
http://onlinelibrary.wiley.com/doi/10.1002/uog.14647/abstract
Human fetal growth is constrained below optimal for perinatal survival
B. Vasak, S.V. Koenen, M.P.H. Koster, C.W.P.M. Hukkelhoven, A. Franx, M.A. Hanson and G.H.A. Visser
Volume 45, Issue 2, Date: February (pages 162–167)
http://onlinelibrary.wiley.com/doi/10.1002/uog.14644/abstract
Placental Elastography in Intrauterine Growth Restriction: A Case–control Studyasclepiuspdfs
Background: Intrauterine growth restriction (IUGR) is related to poor fetal outcome. Though, various tools are available for evaluation of IUGR they are notreliable inearly diagnosis of IUGR. Shear wave elastography (SWE) can be used to study the change in mechanical properties of various disease which can be a potential technique for early diagnosis of IUGR. Objective: The objective of the study was to compare the differences in SWE values of placentas between IUGR and normal pregnancies. Methodology: Normal second- and third-trimester pregnancies and IUGR pregnancies between 24 and 42 weeks period of gestation (POG), meeting the inclusion criteria were matched for age group and POG. SWE of placenta was performed in supine position during quiet respiration. The SWE of placenta was measured by placing the region of interest in relatively homogeneous area. The placental elasticity values obtained in pregnancies complicated by IUGR were compared with that of normal controls. Umbilical artery (UA) and fetal middle cerebral artery (MCA) Doppler findings were correlated with placental elasticity value of IUGR pregnancies.
Aleitamento materno e adiposidade adultaLaped Ufrn
Aleitamento materno e adiposidade adulta (JPed 2014) - Artigo apresentado em Reunião Científica da Liga Acadêmica de Pediatria da UFRN - LAPED UFRN - Natal - RN - Brasil.
the objective is to clarify the problem of recurrent implantation failure , regarding the definition, the caused, diagnosis, and management in cases of IVF
Ahmed Walid Anwar Morad, Professor Obstetrics and Gynecology
Optional procedures alongside the standard IVF protocol to increase the chance of a live birth.
Similar to UOG Journal Club: Optimal risk assessment of small-for-gestational-age fetuses and changes in fetal Doppler indices as markers of failure to reach growth potential
Poor neonatal acid–base status in term fetuses with low cerebroplacental ratio
J. Morales-Roselló, A. Khalil, M. Morlando, A. Bhide, A. Papageorghiou and B. Thilaganathan
Volume 45, Issue 2, Date: February (pages 156–161)
http://onlinelibrary.wiley.com/doi/10.1002/uog.14647/abstract
Human fetal growth is constrained below optimal for perinatal survival
B. Vasak, S.V. Koenen, M.P.H. Koster, C.W.P.M. Hukkelhoven, A. Franx, M.A. Hanson and G.H.A. Visser
Volume 45, Issue 2, Date: February (pages 162–167)
http://onlinelibrary.wiley.com/doi/10.1002/uog.14644/abstract
Placental Elastography in Intrauterine Growth Restriction: A Case–control Studyasclepiuspdfs
Background: Intrauterine growth restriction (IUGR) is related to poor fetal outcome. Though, various tools are available for evaluation of IUGR they are notreliable inearly diagnosis of IUGR. Shear wave elastography (SWE) can be used to study the change in mechanical properties of various disease which can be a potential technique for early diagnosis of IUGR. Objective: The objective of the study was to compare the differences in SWE values of placentas between IUGR and normal pregnancies. Methodology: Normal second- and third-trimester pregnancies and IUGR pregnancies between 24 and 42 weeks period of gestation (POG), meeting the inclusion criteria were matched for age group and POG. SWE of placenta was performed in supine position during quiet respiration. The SWE of placenta was measured by placing the region of interest in relatively homogeneous area. The placental elasticity values obtained in pregnancies complicated by IUGR were compared with that of normal controls. Umbilical artery (UA) and fetal middle cerebral artery (MCA) Doppler findings were correlated with placental elasticity value of IUGR pregnancies.
Fetal growth restriction (FGR), formerly called intrauterine growth restriction (IUGR), refers to a condition in which an unborn baby is smaller than it should be because it is not growing at a normal rate inside the womb.
Mild FGR usually doesn't cause long-term problems. In fact, most babies who have it catch up in height and weight by age 2. But severe FGR can seriously harm a baby before and after birth. The extent of the problems depends on the cause and how severe the growth restriction is. It also depends on what point in the pregnancy it starts.
Cervical length screening for prevention of preterm birth in singleton pregnancy with threatened preterm labor: systematic review and meta-analysis of randomized controlled trials using individual patient-level data
V. Berghella, M. Palacio, A. Ness, Z. Alfirevic, K. H. Nicolaides and G. Saccone
Volume 49, Issue 3, Date: March (pages 322–329)
Slides prepared by Dr Shireen Meher (UOG Editors-for-Trainees)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.17388/full
UOG Journal Club: October 2013
Perinatal morbidity and mortality in early-onset fetal growth restriction: cohort outcomes of the trial of randomized umbilical and fetal flow in Europe (TRUFFLE)
C. Lees, N. Marlow, B. Arabin, C. M. Bilardo, C. Brezinka, J. B. Derks, J. Duvekot, T. Frusca, A. Diemert, E. Ferrazzi, W. Ganzevoort, K. Hecher, P. Martinelli, E. Ostermayer, A. T. Papageorghiou, D. Schlembach, K. T. M. Schneider, B. Thilaganathan, T. Todros, A. van Wassenaer-Leemhuis, A. Valcamonico, G. H. A. Visser and H. Wolf
Link to the free-access article:
http://onlinelibrary.wiley.com/doi/10.1002/uog.13190/abstract
Effects of intrauterine retention and postmortem interval on body weight following intrauterine death: implications for assessment of fetal growth restriction at autopsy
J Man, JC Hutchinson, M Ashworth, AE Heazell, S Levine and NJ Sebire
Volume 47, Issue 11; Date: November, pages 574–578
Read the free-access article here: http://onlinelibrary.wiley.com/doi/10.1002/uog.16018/full
Organ weights and ratios for postmortem identification of fetal growth restriction: utility and confounding factors
J Man, JC Hutchinson, M Ashworth, I Jeffrey, AE Heazell, and NJ Sebire
Volume 48, Issue 5; Date: November, pages 585–590
Read the free-access article here: http://onlinelibrary.wiley.com/doi/10.1002/uog.16017/full
The Journal club for May features 2 papers. The first is a study on Angiogenic Factors vs. Doppler Surveillance in the Prediction of ddverse outcomes in late pregnancy SGA fetuses. The second studies the uterine artery Doppler and sFlt-1/PlGF ratio, discussing its value in diagnosis of early-onset pre-eclampsia.
Angiogenic Factors vs. Doppler Surveillance in the Prediction of Adverse Outcome Among Late-Pregnancy Small-for-Gestational-Age Fetuses
S.M. Lobmaier, F. Figueras, I, Mercade, M. Perello, A. Peguero, F. Crovetto, J.U. Ortiz, F. Crispi and E. Gratacos
Volume 43, Issue 5, Date: May 2014, pages 533-540
Uterine Artery Doppler and sFlt-1/PlGF Ratio: Prognostic Value in Early-Onset Pre-Eclampsia
P.I. Gomez-Arriaga, I. Herraiz, E.A. Lopez-Jiminez, D. Escribano, B. Denk and A. Galindo
Volume 43, Issue 5, Date: May 2014, pages 525-532
Gestational age is a key piece of data used by healthcare providers to determine the timing of various screening tests and assessments of the fetus and mother throughout pregnancy. Gestational age may be assessed at any time during pregnancy, and several modes of assessment exist, each requiring different equipment or skills and with varying degrees of accuracy. Obtaining more accurate estimates of gestational age through better diagnostic approaches may initiate more prompt medical management of a pregnant patient.
Estimation of Fetal Size and Weight using Various Formulasijtsrd
Birth weight is an important factor in delivery management. Antenatal ultrasound has turned out to be one of the clinicians most vital devices for surveying fetal age, growth and prosperity. Contrasted Physical examination of the pregnant uterus is the most precise strategy for evaluating fetal size and growth along with the utilization of ultrasound imaging and estimating of the different fetal parameters. Objective To evaluates the antenatal assessments of fetal weight in pregnancies by using Johnsons formula, Hadlocks formula and Ultrasonography. Comparison of these different methods with the actual birth weight of these babies after delivered. Material and methods Two hundred singleton term pregnancies within 48 hours were randomly selected to participate in this prospective cohort study. Variables included such as abdominal circumference, Biparietal diameter, and Femur length. Parameters to obtain estimated fetal weight Results The mean birth weight of Hadlock formula is closest to the mean of actual birth weight. In the study population, more primigravida delivered babies with very low birth weight and more multigravida delivered babies of birth weight 3500 gms. Johnsons and ultrasound Hadlocks formula had a marked tendency to overestimate the fetal weight. Error was within 350 Gms in 84.7 , 70.8 and 84 of cases by Dares, Johnsons and ultrasound Hadlocks formula. Dr. Pushpamala Ramaiah | Dr. Lamiaa Ahmed Elsayed | Dr. Grace Lindsey | Dr. Ayman Johargy ""Estimation of Fetal Size and Weight using Various Formulas"" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-3 , April 2019, URL: https://www.ijtsrd.com/papers/ijtsrd23231.pdf
Paper URL: https://www.ijtsrd.com/medicine/nursing/23231/estimation-of-fetal-size-and-weight-using-various-formulas/dr-pushpamala-ramaiah
Large randomized trial comparing transabdominal ultrasound-guided embryo transfer with a technique based on uterine length measurement before embryo transfer
A. Revelli, V. Rovei, P. Dalmasso, G. Gennarelli, C. Racca, F. Evangelista, C. Benedetto
Volume 48, Issue 3, Pages 289–295
Read the free-access article:http://onlinelibrary.wiley.com/doi/10.1002/uog.15899/full
Vaginal progesterone decreases preterm birth ≤ 34 weeks of gestation in women with a singleton pregnancy and a short cervix: an updated meta-analysis including data from the OPPTIMUM study
R. Romero, K. H. Nicolaides, A. Conde‐Agudelo, J. M. O'Brien, E. Cetingoz, E. Da Fonseca, G. W. Creasy, S. S. Hassan
Volume 48, Issue 3, Pages 308–317
Read the free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15899/full
Similar to UOG Journal Club: Optimal risk assessment of small-for-gestational-age fetuses and changes in fetal Doppler indices as markers of failure to reach growth potential (20)
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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UOG Journal Club: Optimal risk assessment of small-for-gestational-age fetuses and changes in fetal Doppler indices as markers of failure to reach growth potential
1. UOG Journal Club: March 2014
Optimal risk assessment of small-for-gestational-age fetuses
using 31–34-week biometry in a low-risk population
J. J. Stirnemann, G. Benoist, L. J. Salomon, J.-P. Bernard and Y. Ville
Volume 43, Issue 3, Date: March 2014, pages 311-316
Changes in fetal Doppler indices as a marker of failure to reach
growth potential at term
J. Morales-Roselló, A. Khalil, M. Morlando, A. Papageorghiou,
A.Bhide and B. Thilaganathan
Volume 43, Issue 3, Date: March 2014, pages 303-310
Journal Club slides prepared by Dr Aly Youssef
(UOG Editor for Trainees)
2. UOG Journal Club: March 2014
Optimal risk assessment of small-for-gestational-age
fetuses
using 31–34-week biometry in a low-risk population
J. J. Stirnemann, G. Benoist, L. J. Salomon,
J.-P. Bernard and Y. Ville
Volume 43, Issue 3, Date: March 2014, pages 311-316
3. Optimal risk assessment of small-for-gestational-age fetuses
using 31–34-week biometry in a low-risk population
Stirnemann et al., UOG 2014
Introduction
• Late-pregnancy intrauterine growth restriction (IUGR) remains a
leading cause of unanticipated perinatal death and morbidity
after 34 weeks’ gestation
• The detection and follow-up of fetuses at risk are necessary for
optimal management and planning of delivery
• Estimated fetal weight (EFW) using a cross-sectional agespecific percentile as a selection criterion of altered growth
remains the most widely used method to prenatally assess the
likelihood of IUGR
4. Optimal risk assessment of small-for-gestational-age fetuses
using 31–34-week biometry in a low-risk population
Stirnemann et al., UOG 2014
Objective
To compare the performance of traditional growth charts for
EFW and a validated pragmatic probabilistic approach using
biometry at 31–34weeks’ gestation to screen for late
pregnancy small-for-gestational age (SGA) fetuses in
a low-risk population.
5. Methods
Training dataset
•Records of 7755 women presenting at 31–34 weeks following normal
aneuploidy screening in the 1st or 2nd trimester, and normal 20-24 wks
scan.
•Only cases with known birth weight and gestational age at delivery, with
gestational age at delivery ≥37 weeks were included.
•Prenatal and postnatal malformations and cases with absent or reversed
diastolic flow in the umbilical artery were excluded.
Validation dataset
•1725 women recruited at 11-14 weeks onwards.
•
At 31-34 weeks biparietal diameter, head circumference, abdominal
circumference and femur length were measured.
6. Methods
Defining SGA
•Analysis of data was conducted for different definitions of SGA including birth
weight <3rd, 5th, and 10th centiles, and birth weight <2500 grams.
The probabilistic model
•
A logistic regression model was built for each type of ultrasound
measurement, computed using locally-derived growth charts.
•
The results were displayed in terms of false-positive rate and detection rate
of SGA, bypassing the intermediate step of EFW calculation.
•
The potential additional value of maternal characteristics such as smoking
status, parity, body mass index (BMI) and age were also investigated.
•
External validation was performed by comparing observed prevalence and
predictions given by the model in the second independent dataset.
This model was compared with the routinely used multistep approach involving
estimation of fetal weight and consecutive screening by a percentile cut-off.
7. Optimal risk assessment of small-for-gestational-age fetuses
using 31–34-week biometry in a low-risk population
Stirnemann et al., UOG 2014
Results
Accuracy of predicting birth weight <10th centile
Probabilistic
approach
Area under the
ROC curve
Model using EFW
P value
0.832
0.828
0.007
•
For a 10% false-positive rate, the probabilistic approach yielded a 51%
detection rate for birth weight<10th centile, compared to the 32% and
48% detection by the 10th centile cut-off of two EFW reference charts.
•
Adding maternal characteristics significantly improved detection of SGA
by 2%, from 51% to 53%.
8. Optimal risk assessment of small-for-gestational-age fetuses
using 31–34-week biometry in a low-risk population
Stirnemann et al., UOG 2014
Conclusion
• As the main goal of ultrasound biometry is to detect abnormal growth,
the suggested probabilistic model using biometric measurements seems
a reasonable and pragmatic approach.
• This may unify screening procedures and simplify counselling at 31-34
weeks.
• In addition, it allows the direct incorporation of maternal-specific
characteristics, thus having the potential to replace customized growth
charts.
• This screening strategy is however intended for low-risk population and
is not validated in high risk pregnancies, or outside the 31-34 weeks
window.
9. Optimal risk assessment of small-for-gestational-age fetuses
using 31–34-week biometry in a low-risk population
Stirnemann et al., UOG 2014
Weaknesses
• Some important maternal covariates, such as ethnicity, were
not recorded.
• The sample size may still limit the accuracy of parameter
estimation for very low birth weights.
• This approach is not validated for high risk pregnancies.
10. Discussion points
•
Should low-risk women be offered an ultrasound scan with fetal
weight estimation in the third trimester?
•
Would the probabalistic method be superior to the use of
customized growth charts to detect SGA at term?
•
Which cut-off of estimated fetal weight/fetal biometric
measurements should be used to define IUGR?
•
How should pregnancies with SGA fetuses at term with normal
Doppler indices be managed?
•
How should pregnancies with AGA fetuses at term with abnormal
Doppler indices be managed?
11. UOG Journal Club: March 2014
Changes in fetal Doppler indices as a marker of failure to
reach growth potential at term
J. Morales-Roselló, A. Khalil, M. Morlando, A.
Papageorghiou, A. Bhide and B. Thilaganathan
Volume 43, Issue 3, Date: March 2014, pages 303-310
12. Fetal doppler changes as a marker of failure to reach growth potential at term
Morales-Roselló et al., UOG 2014
Background
SGA = fetus with EFW <10th centile (i.e. small-for-gestational age).
FGR = fetus unable to achieve its genetically determined size as a
consequence of placental insufficiency (typically defined as SGA with
evidence of placental insufficiency.
• The standard definitions of both SGA and FGR exclude apparently
appropriate for gestational age (AGA) infants that are growth
restricted (e.g. birth-weight (BW) on the 40th centile with genetic
potential to be born on the 80th centile).
• To date, the identification of AGA fetuses affected by occult chronic
placental insufficiency, fetal hypoxemia and failure to reach growth
potential (FRGP) remains challenging.
13. Fetal doppler changes as a marker of failure to reach growth potential at term
Morales-Roselló et al., UOG 2014
Objective
To determine whether AGA fetuses at term exhibit changes in
middle cerebral artery (MCA) and umbilical artery (UA) Doppler
indices that may be of value in identifying those that are
affected by placental insufficiency and subsequent FRGP.
14. Fetal doppler changes as a marker of failure to reach growth potential at term
Morales-Roselló et al., UOG 2014
Methods
Retrospective cohort in a tertiary centre from 2002-2012.
Inclusion criteria
•Singleton pregnancies.
•Morphologically normal and term fetuses.
•Ultrasound performed within 14 days before date of
delivery.
•
•
•
•
•
Exclusion criteria
•Fetal abnormality.
•Aneuploidy.
•Antepartum stillbirth.
UA and MCA were examined using color Doppler and the pulsatility index
(PI) was measured.
Cerebroplacental ratio (CPR) was calculated = MCA PI / UA PI.
All Doppler indices were converted into multiples of the median (MoM) for
gestational age.
Doppler PI MoM values were represented in scatter graphs according to BW
centile, and linear regression analysis was calculated evaluating the
presence of statistical significance.
Doppler measurements were then grouped according to BW quartiles and
compared.
15. Fetal doppler changes as a marker of failure to reach growth potential at term
Morales-Roselló et al., UOG 2014
Methods
• As the group of largest fetuses (>90th centile) was assumed
to include those least likely to be FRGP, the CPR 5th centile
from this group (optimal CPR) was preliminarily established
as the normality threshold to indicate placental insufficiency.
• The proportion of fetuses with FRGP was estimated in each
group by subtracting the proportion of fetuses with a CPR
below this optimal CPR limit.
16. Fetal doppler changes as a marker of failure to reach growth potential at term
Morales-Roselló et al., UOG 2014
Results
Cerebroplacental ratio MoM
MCA PI/UA PI MoM
Linear regression analysis showed
that AGA fetuses with lower
BW centiles had significantly:
1.higher UA PI MoM
2.lower MCA PI MoM
3.lower CPR MoM
BW centiles
17. Fetal doppler changes as a marker of failure to reach growth potential at term
Morales-Roselló et al., UOG 2014
Results
Cerebroplacental
ratio MoM intervals
Compared to fetuses >75th BW
centile, AGA fetuses in the
CPR MoM
lower quartiles had lower CPR
MoM, suggesting that some of
these pregnancies were
affected by placental
insufficiency and FRGP.
BW centiles
18. Fetal doppler changes as a marker of failure to reach growth potential at term
Morales-Roselló et al., UOG 2014
Results: proportion of fetuses with failure to reach growth potential (FRGP)
Proportion of fetuses with FRGP
(% of fetuses with FRGP were calculated after subtracting those cases with CPR MoM <5th
centile observed in the group with BW >90th centile)
BW centile
75-90th centile
1%
50-75th centile
1.7%
25-50th centile
2.9%
10-25th centile
BW centile groups
% of fetuses with
FRGP
6.7%
19. Fetal doppler changes as a marker of failure to reach growth potential at term
Morales-Roselló et al., UOG 2014
Discussion
•
The data presented in this study demonstrate that in term AGA pregnancies,
Doppler indices suggestive of fetal hypoxemia are more prevalent in the lower
AGA BW centiles.
•
The study findings imply that Doppler indices have the potential to identify AGA
fetuses that are affected by placental insufficiency and failing to reach their
genetic growth potential, as evidenced by blood flow redistribution.
•
This finding challenges the conventional paradigm that only SGA fetuses are at
risk of placental insufficiency, fetal hypoxemia and FRGP.
•
It is still unknown whether the degree of placental insufficiency leading to FRGP
in these AGA fetuses is predictive for perinatal complications and childhood
developmental problems as seen in SGA and IUGR neonates.
20. Fetal doppler changes as a marker of failure to reach growth potential at term
Morales-Roselló et al., UOG 2014
Future perspectives
Future studies are needed to evaluate the performance of the CPR in
AGA fetuses in the prediction of neonatal neurodevelopmental
impairment, with the aim of optimizing the timing of delivery and
reducing long-term neonatal handicap.
Discussion points
• How should women at term with appropriate for gestational age fetuses
and evidence of circulatory redistribution be managed?
• Which cut-off of cerebroplacental ratio should be used to define fetal
blood flow redistribution?
• Should middle cerebral artery and umbilical artery be performed in
women with appropriate for gestational age fetuses?