OC249: Predictive value of antenatal umbilical artery Doppler for adverse pregnancy outcome in small-for-gestational age babies according to customized birth weight centiles

The sFlt-1/PlGF ratio has high sensitivity and specificity to diagnose preeclampsia (PE) and to predict pregnancy outcome. Especially in patients with preexisting hypertension and/or proteinuria, diagnosis and management of PE is challenging. We studied the predictive value of the sFlt-1/PlGF ratio for the occurrence of adverse outcome in patients with a high prevalence of preexisting hypertension or proteinuria, clinically suspected of having PE. A sFlt-1/PlGF ratio >= 85 was considered to be a positive test. Adverse pregnancy outcome was defined as HELPP syndrome, intra-uterine growth restriction, or perinatal death. The predictive value of adverse pregnancy outcome of preeclampsia based on clinical grounds (clinical PE) or of a positive ratio was compared using a logistic regression model corrected for gestational age at testing. Results: So far 64 patients with a gestational age (GA) of 29.3 wks (range 20-37 wks) were included. 19 had preexisting hypertension, 5 had preexisting proteinuria and 6 had both conditions. At time of measurement 23 patients had clinical PE (4 with a negative ratio) and 30 patients had a positive sFlt-1/PlGF test (11 without clinical PE at testing of whom 7 developed clinical PE within 2 wks). 27% of patients had an adverse outcome of pregnancy. GA between patients with clinical PE or a positive test did not differ. Patients with clinical PE at the time of testing had an odds ratio of 2.5 (95% CI: 0.75 - 7.8) and patients with a positive test had an odds ratio of 6.8 (95% CI;2.1 - 33.9) for an adverse outcome. Patients with clinical PE had an absolute risk for an adverse outcome of 39% (9/23) compared to 46%(14/30) for patients with a positive sFlt-1/PlGF test (p=.075) In patients where the diagnosis of PE is challenging because of preexisting hypertension and/or proteinuria a positive sFlt-1/PlGF is a stronger determinant for poor pregnancy outcome than the clinical diagnosis of PE. An explanation could be that a positive ratio can select patients that will develop PE in the near future and because of misclassification of patients with preexisting hypertension and/or proteinuria.

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Small for gestational age (SGA) and large for gestational age (LGA) in gestational diabetes: Is there a difference in adverse pregnancy outcome?

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2005.10.324 ◽

2005 ◽

Vol 193 (6) ◽

pp. S95

Author(s):

Yariv Yogev ◽

Oded Langer

Keyword(s):

Gestational Diabetes ◽

Pregnancy Outcome ◽

Gestational Age ◽

Small For Gestational Age ◽

Adverse Pregnancy Outcome ◽

Large For Gestational Age ◽

Adverse Pregnancy

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The PLANES study: a protocol for a randomised controlled feasibility study of the placental growth factor (PlGF) blood test-informed care versus standard care alone for women with a small for gestational age fetus at or after 32 + 0 weeks’ gestation

Pilot and Feasibility Studies ◽

10.1186/s40814-020-00722-x ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Joanna Gent ◽

Sian Bullough ◽

Jane Harrold ◽

Richard Jackson ◽

Kerry Woolfall ◽

...

Keyword(s):

Pregnancy Outcome ◽

Feasibility Study ◽

Gestational Age ◽

Small For Gestational Age ◽

Standard Care ◽

Adverse Pregnancy Outcome ◽

Adverse Pregnancy ◽

Randomised Controlled ◽

The Uk ◽

Plgf Ratio

Abstract Background Stillbirth remains a major concern across the globe and in some high-resource countries, such as the UK; efforts to reduce the rate have achieved only modest reductions. One third of stillborn babies are small for gestational age (SGA), and these pregnancies are also at risk of neonatal adverse outcomes and lifelong health problems, especially when delivered preterm. Current UK clinical guidance advocates regular monitoring and early term delivery of the SGA fetus; however, the most appropriate regimen for surveillance of these babies remains unclear and often leads to increased intervention for a large number of these women. This pilot trial will determine the feasibility of a large-scale trial refining the risk of adverse pregnancy outcome in SGA pregnancies using biomarkers of placental function sFlt-1/PlGF, identifying and intervening in only those deemed at highest risk of stillbirth. Methods PLANES is a randomised controlled feasibility study of women with an SGA fetus that will be conducted at two tertiary care hospitals in the UK. Once identified on ultrasound, women will be randomised into two groups in a 3:1 ratio in favour of sFlt-1/PlGF ratio led management vs standard care. Women with an SGA fetus and a normal sFlt-1/PlGF ratio will have a repeat ultrasound and sFlt-1/PlGF ratio every 2 weeks with planned birth delayed until 40 weeks. In those women with an SGA fetus and an abnormal sFlt-1/PlGF ratio, we will offer birth from 37 weeks or sooner if there are other concerning features on ultrasound. Women assigned to standard care will have an sFlt-1/PlGF ratio taken, but the results will be concealed from the clinical team, and the woman’s pregnancy will be managed as per the local NHS hospital policy. This integrated mixed method study will also involve a health economic analysis and a perspective work package exploring trial feasibility through interviews and questionnaires with participants, their partners, and clinicians. Discussion Our aim is to determine feasibility through the assessment of our ability to recruit and retain participants to the study. Results from this pilot study will inform the design of a future large randomised controlled trial that will be adequately powered for adverse pregnancy outcome. Such a study would provide the evidence needed to guide future management of the SGA fetus. Trial registration ISRCTN58254381. Registered on 4 July 2019

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Study of abnormal umbilical artery doppler and neonatal outcome

Asian Journal of Medical Sciences ◽

10.3126/ajms.v10i5.25135 ◽

2019 ◽

Vol 10 (5) ◽

pp. 98-101

Author(s):

Gyawali Merina ◽

Poudel Ramesh

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Gestational Age ◽

Small For Gestational Age ◽

Predictive Value ◽

Umbilical Artery ◽

Neonatal Outcome ◽

Perinatal Asphyxia ◽

Appropriate For Gestational Age ◽

Umbilical Artery Doppler

Background: Doppler provides assessment of uteroplacental and fetoplacental circulation during pregnancy. It is a sensitive tool in early detection of fetal compromise and allows needful intervention. Aims and Objective: To study the role of umbilical artery doppler in clinically suspected IUGR and its implication on neonatal outcome. Materials and Methods: A total of 104 singleton pregnancies with gestational age of more than 34 weeks who had clinical suspicion of IUGR were evaluated using obstetric ultrasound and doppler. Umbilical arteryvelocimetry with S/D >3 and RI >0.7 were considered abnormal. Newborns were classified as either small for gestational age (SGA) ie, IUGR or appropriate for gestational age (AGA). Neonatal outcome were classified as either normal or adverse events that included still birth, NICU admissions, perinatal asphyxia and/or neonatal death. Results: Out of 104 clinically suspected IUGR, 55 were born with small for gestational age. Among these SGA neonates, 45 subjects had abnormal umbilical artery S/D and 42 had abnormal RI. Abnormal umbilicalartery S/D ratio had a sensitivity of 81.8 %, specificity of 59.2 %, the positive predictive value of 69.2 % and negative predictive value of 74.4 %. Abnormal Umbilical artery RI had a sensitivity of 76.4 %, specificity of 69.4 %, positive predictive value of 73.7 % and negative predictive value of 72.3 % in diagnosing IUGR. Abnormal umbilical artery velocimetry was associated with increased morbidity and mortality in IUGR neonates. Conclusions: Umbilical artery doppler plays an important role in diagnosing IUGR and predicting neonatal outcome.

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Adverse pregnancy outcome and association with small for gestational age birthweight by customized and population-based percentiles

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2009.04.034 ◽

2009 ◽

Vol 201 (1) ◽

pp. 28.e1-28.e8 ◽

Cited By ~ 110

Author(s):

Jason Gardosi ◽

Andre Francis

Keyword(s):

Pregnancy Outcome ◽

Gestational Age ◽

Small For Gestational Age ◽

Adverse Pregnancy Outcome ◽

Population Based ◽

Adverse Pregnancy

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Midtrimester Isolated Short Femur Length as a Predictor of Adverse Pregnancy Outcome

Fetal Diagnosis and Therapy ◽

10.1159/000375446 ◽

2015 ◽

Vol 38 (3) ◽

pp. 205-211 ◽

Cited By ~ 7

Author(s):

Amir Aviram ◽

Ron Bardin ◽

Arnon Wiznitzer ◽

Yariv Yogev ◽

Eran Hadar

Keyword(s):

Birth Weight ◽

Retrospective Analysis ◽

Gestational Age ◽

Small For Gestational Age ◽

Pregnancy Complications ◽

Adverse Pregnancy Outcome ◽

Study Group ◽

Femur Length ◽

Hypertensive Disorders ◽

Adverse Pregnancy

Objective: The aim of this study was to investigate whether midtrimester isolated short femur length is associated with pregnancy complications. Study Design: Retrospective analysis of pregnancies with a midtrimester femur length <5th percentile for gestational age compared to controls with a femur length ≥5th percentile. Outcome measures included hypertensive disorders, being small for gestational age, oligohydramnios and preterm delivery. Results: 2,105 women were eligible for this study, 85 (3.45%) of whom were in the study group and 2,020 were controls. Birth weight <10th percentile for gestational age (OR 4.4, 95% CI 2.5-7.8), birth weight <3rd percentile for gestational age (OR 31.0, 95% CI 13.3-72.3) and severe preeclampsia (OR 6.3, 95% CI 1.4-28.6) were significantly associated with midtrimester isolated short femur length. Conclusions: Midtrimester isolated short femur length is associated with higher rates of being small for gestational age and preeclampsia.

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