(586) Umbilical artery Doppler abnormalities in fetal growth restriction defined by isolated lagging abdominal circumference

Thursday, February 9, 2023

4:00 PM – 5:30 PM

Objective: Recent guidelines endorsed by the Society of Maternal Fetal Medicine recommended an updated diagnostic criterion for fetal growth restriction (FGR) to include a sonographic abdominal circumference (AC) < 10% or estimated fetal weight (EFW) < 10% rather than EFW alone based upon similar detection of small for gestational age (SGA) birthweight. However, SGA is a postnatal diagnosis and cannot be used for antenatal management and data on umbilical artery Doppler (UAD) is limited. The objective of this study was to assess diagnosis of FGR by AC versus EFW to detect abnormal UAD.

Study Design: This was a retrospective cohort study of all patients with a singleton non-anomalous gestation meeting diagnostic criteria for FGR between 2017-2021 at a single center. Patients were grouped by diagnosis criteria: 1) Isolated AC lag (AC < 10% & EFW >10%) or 2) EFW < 10% (with or without AC < 10%). Rates of abnormal UAD (S/D >95% or absent or reversed end-diastolic flow [AREDF]) were compared between groups. ROC curves were used to calculate area under the curve (AUC) for abnormal UAD. Logistic regression was used to generate odds ratios (OR) and 95% confidence intervals (CI) for abnormal UAD between diagnostic groups.

Results: There were 1,812 patients included in the analysis with 343 meeting FGR criteria by AC and 1,469 by EFW. Isolated AC progressed to an EFW < 10% in 66 (19.2%) and resolved in 89 (26.0%) of patients. Isolated AC had lower rates of elevated UAD (9.9% vs 18.5%; p< .001) and AREDF at diagnosis (0.7% vs. 5.1%; p=.001) when compared to EFW. Isolated AC lag at diagnosis had a significantly lower odds of any abnormal UAD (OR 0.38, CI 0.25-0.56). Overall, EFW criterion had a higher AUC for detection of AREDF (0.845 vs. 0.680; p< .001, Figure 1) and elevated UAD (0.657 vs. 0.612; p=.024, Figure 2).

Conclusion: Isolated AC < 10% appears to have a higher likelihood of identifying constitutional rather than pathologic fetal growth with significantly reduced rates of abnormal UAD at diagnosis. Overall, EFW percentile is a better predictor than AC for abnormal UAD, particularly for AREDF.

Primary & Presenting Author(s)

Ralitza H. Peneva, MD
Medical University of South Carolina
Johns Island, South Carolina, United States

Coauthor(s)

Kelli M. McFarling, MD
Medical University of South Carolina
Charleston, South Carolina, United States
Eliza R. McElwee, MD
MD
Medical University of South Carolina
Charleston, South Carolina, United States
RW
Rebecca Wineland, MD
Medical University of South Carolina
Charleston, South Carolina, United States
MF
Matthew M. Finneran, MD
Assistant Professor
Medical University of South Carolina
Charleston, South Carolina, United States