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99: Uterine artery Doppler at IUGR diagnosis–can it predict adverse perinatal outcome?
www.AJOG.org
Ultrasound, Fetus, Genetics
1
Royal College of Surgeons in Ireland, Obstetrics & Gynecology, Dublin, Ireland, 2University College Cork, Cork University Maternity Hospital, Obstetrics & Gynecology, Cork, Ireland, 3Coombe Women and Infants University Hospital, Obstetrics & Gynecology, Dublin, Ireland, 4Rotunda Hospital, Obstetrics & Gynecology, Dublin, Ireland, 5UCD Center for Human Reproduction, Coombe Women and Infants University Hospital, Obstetrics & Gynecology, Dublin, Ireland, 6UCD School of Medicine and Medical Science, National Maternity Hospital, Obstetrics & Gynecology, Dublin, Ireland, 7 Royal Jubilee Maternity Hospital, Obstetrics & Gynecology, Belfast, Ireland, 8 National University of Ireland, Obstetrics & Gynecology, Galway, Ireland, 9 Graduate Entry Medical School, University of Limerick, Obstetrics & Gynecology, Limerick, Ireland, 10Royal College of Surgeons in Ireland, Epidemiology & Public Health, Dublin, Ireland
OBJECTIVE: The aim of the Prospective Observational Trial to Optimize Pediatric Health in IUGR (PORTO) Study was to evaluate the optimal management of fetuses with EFW<10th centile. Customization of fetal growth has been proposed to provide improved identification of IUGR taking into account physiological maternal and fetal variables. The objective of this secondary analysis was to test whether customization of fetal growth (EFWcust) performs better in identifying fetuses at risk of adverse perinatal outcome when compared to conventional population standards (EFWpop). STUDY DESIGN: Over 1,100 consecutive ultrasound-dated singleton pregnancies with EFWpop<10th centile were subjected to sonographic surveillance at least every two weeks with biometry and multi-vessel Doppler assessment at each visit. Co-efficients for customized growth standards were derived from over 11,000 singleton pregnancies in Ireland and applied to the PORTO cohort. Adverse perinatal outcome was defined as composite outcome of IVH, PVL, HIE, NEC, BPD, sepsis or death. RESULTS: Of the 1,116 fetuses with EFWpop<10th centile (Hadlock4), 72% (800) remained <10th centile when adjusted for maternal factors and fetal gender (EFWcust). If customized centiles had been used, 316 (28%) would not have been considered true cases of IUGR. The rate of adverse perinatal outcome was 6.4% (51/800) in those with EFWcust<10th and 2% (6/316) in those with EFWcust>10th centile. This represents a 25% increase in the risk (RR¼1.25) of detecting an adverse outcome using customized centiles compared with standard population centiles. When applying customized centiles to actual birthweights (BW), 64% (714) infants in the overall cohort had a BW <10th customized centile, compared to 72% (796) with BW <10th centile using population norms. CONCLUSION: Results of this large prospective study validate the usefulness of fetal weight customization for the most appropriate identification of fetal growth restriction in the antenatal setting.
Poster Session I
Galway, Ireland, 10Graduate Entry Medical School, University of Limerick, Obstetrics & Gynecology, Limerick, Ireland
OBJECTIVE: The aim of the Prospective Observational Trial to Opti-
mize Pediatric Health in IUGR (PORTO) Study was to evaluate the optimal management of fetuses with EFW<10th centile. The objective of this secondary analysis was to describe the growth dynamics of fetuses outgrowing the 10th centile with respect to perinatal outcomes and maternal risk factors. STUDY DESIGN: Over 1,100 consecutive ultrasound-dated singleton pregnancies with EFW<10th centile were subjected to sonographic surveillance at least every two weeks with biometry and multi-vessel Doppler assessment at each visit. Delivery and perinatal outcomes were recorded for each pregnancy. This particular analysis focused on ‘Growers’, defined as fetuses crossing the threshold for IUGR definition >10th centile as opposed to ‘Showers’, fetuses who remained <10th centile until delivery. RESULTS: Of the 1,116 recruited IUGR fetuses, 193 (17%) subsequently had an EFW>10th centile on their last sonogram prior to delivery confirmed by birthweight >10th centile. The mean GA at enrollment was 28.6+/-4.0 weeks. As outlined in figure 1, outgrowing the 10th centile was a gradual process with considerable variation from fetus to fetus. 61 (32%) crossed the 10th centile by 32 weeks, 56 (29%) between 32 and 36 weeks and 75 (39%) after 36 weeks. The majority of ‘Growers’ (82%; 159/193) remained >10th centile for all subsequent scans. Mothers of ‘Growers’ were less likely to be smokers (14% vs 25%; p<0.001) or affected by hypertensive pregnancy complications (2% vs 11%; p<0.001). 49 (25%) had an abnormal UA Doppler after enrollment, however in the majority of cases (67%; 33/49) this was a single event. There was only one adverse outcome among the 193 infants, a case of sepsis at 37 weeks. CONCLUSION: There are dynamic growth changes in IUGR fetuses with 17% outgrowing their original diagnosis. Positive growth spurts in utero more commonly occur in healthy mothers. Once a fetus has outgrown the 10th centile, consideration could be given to decreasing antenatal surveillance.
98 Intrauterine growth restrictioneare you a grower or a shower? Fiona Cody1, Julia Unterscheider2, Patrick Dicker3, Elizabeth Tully2, Sean Daly4, Michael Geary1, Mairead Kennelly5, Fionnuala McAuliffe6, Keelin O’Donoghue7, Alsyon Hunter8, John Morrison9, Gerard Burke10, Fergal Malone2 1 Rotunda Hospital, Obstetrics & Gynecology, Dublin, Ireland, 2Royal College of Surgeons in Ireland, Obstetrics & Gynecology, Dublin, Ireland, 3Royal College of Surgeons in Ireland, Epidemiology & Public Health, Dublin, Ireland, 4Coombe Women and Infants University Hospital, Obstetrics & Gynecology, Dublin, Ireland, 5UCD Center for Human Reproduction, Coombe Women and Infants University Hospital, Obstetrics & Gynecology, Dublin, Ireland, 6UCD School of Medicine and Medical Science, National Maternity Hospital, Obstetrics & Gynecology, Dublin, Ireland, 7University College Cork, Cork University Maternity Hospital, Obstetrics & Gynecology, Cork, Ireland, 8Royal Jubilee Maternity Hospital, Obstetrics & Gynecology, Belfast, Ireland, 9National University of Ireland, Obstetrics & Gynecology,
99 Uterine artery Doppler at IUGR diagnosisecan it predict adverse perinatal outcome? Julia Unterscheider1, Keelin O’Donoghue2, Sean Daly3, Michael Geary4, Mairead Kennelly5, Fionnuala McAuliffe6, Alyson Hunter7, John Morrison8, Gerard Burke9, Patrick Dicker10, Elizabeth Tully1, Fergal Malone1
Supplement to JANUARY 2014 American Journal of Obstetrics & Gynecology
S63
Poster Session I
Ultrasound, Fetus, Genetics
1
Royal College of Surgeons in Ireland, Obstetrics & Gynecology, Dublin, Ireland, 2University College Cork, Cork University Maternity Hospital, Obstetrics & Gynecology, Cork, Ireland, 3Coombe Women and Infants University Hospital, Obstetrics & Gynecology, Dublin, Ireland, 4Rotunda Hospital, Obstetrics & Gynecology, Dublin, Ireland, 5UCD Center for Human Reproduction, Coombe Women and Infants University Hospital, Obstetrics & Gynecology, Dublin, Ireland, 6UCD School of Medicine and Medical Science, National Maternity Hospital, Obstetrics & Gynecology, Dublin, Ireland, 7 Royal Jubilee Maternity Hospital, Obstetrics & Gynecology, Belfast, Ireland, 8 National University of Ireland, Obstetrics & Gynecology, Galway, Ireland, 9 Graduate Entry Medical School, University of Limerick, Obstetrics & Gynecology, Limerick, Ireland, 10Royal College of Surgeons in Ireland, Epidemiology & Public Health, Dublin, Ireland
OBJECTIVE: The aim of the Prospective Observational Trial to Optimize Pediatric Health in IUGR (PORTO) Study was to evaluate the optimal management of fetuses with EFW<10th centile. The objective of this secondary analysis was to establish whether an abnormal uterine artery (UtA) Doppler at IUGR diagnosis can be utilized to predict subsequent adverse perinatal outcome. STUDY DESIGN: Over 1,100 consecutive ultrasound-dated singleton pregnancies with EFW<10th centile were subjected to sonographic surveillance at least every two weeks with biometry and multi-vessel Doppler assessment at each visit. Uterine artery Doppler was recorded once at enrollment to the study. Adverse perinatal outcome was defined as composite outcome consisting of intraventricular hemorrhage, periventricular leucomalacia, hypoxic ischemic encephalopathy, necrotizing enterocolitis, bronchopulmonary dysplasia, sepsis or death. Comparisons were performed using Fisher’s exact test and p<0.05 was considered significant. RESULTS: Of the 1,116 pregnancies completing the study protocol, 823 (74%) had uterine artery Doppler assessment at enrollment (mean GA 31 weeks; IQR¼28-34 weeks). Abnormal uterine artery Doppler, defined as either presence of notching or UtA pulsatility index (PI) >95th centile was observed in 26% (n¼214) cases. Uterine artery abnormalities identified 58% (n¼25) of adverse perinatal outcomes (Table 1) and 66% (n¼53) of IUGR pregnancies complicated by pre-eclampsia. The sensitivity for predicting adverse perinatal outcome by UtA Doppler alone was 58%. The negative predictive value (NPV) of UtA Doppler was 97%. CONCLUSION: Abnormal uterine artery Doppler at IUGR diagnosis is strongly associated with adverse perinatal outcome and preeclamptic pregnancy complications. If the uterine artery Doppler is normal at IUGR diagnosis, the risk of adverse outcome is very small. Therefore UtA Doppler evaluation could be incorporated into the risk stratification of IUGR pregnancies at diagnosis, even in the late second and third trimester.
Abnormal uterine artery Doppler and adverse perinatal outcome
www.AJOG.org
100 Clinical significance of placental lesions in IUGReresults from a national prospective study Julia Unterscheider1, Emma Doyle2, Deirdre Devaney2, Brendan Fitzgerald3, Keelin O’Donoghue4, Sean Daly5, Michael Geary6, Mairead Kennelly7, Fionnuala McAuliffe8, Alyson Hunter9, John Morrison10, Gerard Burke11, Patrick Dicker12, Elizabeth Tully1, Fergal Malone1 1 Royal College of Surgeons in Ireland, Obstetrics & Gynecology, Dublin, Ireland, 2Rotunda Hospital, Pathology, Dublin, Ireland, 3Cork University Hospital, Pathology, Cork, Ireland, 4University College Cork, Cork University Maternity Hospital, Obstetrics & Gynecology, Cork, Ireland, 5Coombe Women and Infants University Hospital, Obstetrics & Gynecology, Dublin, Ireland, 6Rotunda Hospital, Obstetrics & Gynecology, Dublin, Ireland, 7UCD Center for Human Reproduction, Coombe Women and Infants University Hospital, Obstetrics & Gynecology, Dublin, Ireland, 8UCD School of Medicine and Medical Science, National Maternity Hospital, Obstetrics & Gynecology, Dublin, Ireland, 9Royal Jubilee Maternity Hospital, Obstetrics & Gynecology, Belfast, Ireland, 10National University of Ireland, Obstetrics & Gynecology, Galway, Ireland, 11Graduate Entry Medical School, University of Limerick, Obstetrics & Gynecology, Limerick, Ireland, 12 Royal College of Surgeons in Ireland, Epidemiology & Public Health, Dublin, Ireland
OBJECTIVE: The aim of the Prospective Observational Trial to Opti-
mize Pediatric Health in IUGR (PORTO) Study was to evaluate the optimal management of fetuses with EFW<10th centile. The objective of this analysis was to identify clinical and placental pathological features in fetuses with EFW<10th centile that distinguish those affected by adverse perinatal outcomes from unaffected fetuses. STUDY DESIGN: The multicenter PORTO Study recruited 1,200 pregnancies with EFW<10th and subjected them to intensive antenatal sonographic surveillance. Adverse perinatal outcome was defined as composite outcome of IVH, PVL, HIE, NEC, BPD, sepsis or death. Placentas from a single center were included to ensure uniform handling and reporting. Placental pathology was categorized into villous development abnormalities, maternal and fetal vascular pathologies and inflammatory lesions. RESULTS: Of the 260 placentas evaluated in this single center, 72% (n¼187) of fetuses remained <10th centile until delivery. Infants with adverse outcome were delivered significantly earlier resulting in lower birthweights (p<0.0001). The earlier delivery was precipitated by the clinical severity of IUGR (p<0.0001). Placentas of infants with adverse outcome were smaller with increased placental/ birthweight ratio (p<0.001), both of which relate to earlier gestation at delivery. The occurrence of nucleated erythroblasts as a sign of intrauterine hypoxia was significantly more common in the adverse outcome group (p¼0.0001). Other placental findings significantly associated with adverse outcome after multivariate analysis adjusting for gestational age at delivery were accelerated villous maturation, distal villous hypoplasia and increased syncytial knotting (Table 1). CONCLUSION: Adverse perinatal outcome in IUGR is significantly associated with earlier gestation at delivery, severity of IUGR, UA Doppler abnormalities, placental evidence of intrauterine fetal hypoxia and alterations in placental villous development.
*Fisher exact test; significance level p<0.05.
S64 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2014
Ultrasound, Fetus, Genetics
1
Royal College of Surgeons in Ireland, Obstetrics & Gynecology, Dublin, Ireland, 2University College Cork, Cork University Maternity Hospital, Obstetrics & Gynecology, Cork, Ireland, 3Coombe Women and Infants University Hospital, Obstetrics & Gynecology, Dublin, Ireland, 4Rotunda Hospital, Obstetrics & Gynecology, Dublin, Ireland, 5UCD Center for Human Reproduction, Coombe Women and Infants University Hospital, Obstetrics & Gynecology, Dublin, Ireland, 6UCD School of Medicine and Medical Science, National Maternity Hospital, Obstetrics & Gynecology, Dublin, Ireland, 7 Royal Jubilee Maternity Hospital, Obstetrics & Gynecology, Belfast, Ireland, 8 National University of Ireland, Obstetrics & Gynecology, Galway, Ireland, 9 Graduate Entry Medical School, University of Limerick, Obstetrics & Gynecology, Limerick, Ireland, 10Royal College of Surgeons in Ireland, Epidemiology & Public Health, Dublin, Ireland
OBJECTIVE: The aim of the Prospective Observational Trial to Optimize Pediatric Health in IUGR (PORTO) Study was to evaluate the optimal management of fetuses with EFW<10th centile. Customization of fetal growth has been proposed to provide improved identification of IUGR taking into account physiological maternal and fetal variables. The objective of this secondary analysis was to test whether customization of fetal growth (EFWcust) performs better in identifying fetuses at risk of adverse perinatal outcome when compared to conventional population standards (EFWpop). STUDY DESIGN: Over 1,100 consecutive ultrasound-dated singleton pregnancies with EFWpop<10th centile were subjected to sonographic surveillance at least every two weeks with biometry and multi-vessel Doppler assessment at each visit. Co-efficients for customized growth standards were derived from over 11,000 singleton pregnancies in Ireland and applied to the PORTO cohort. Adverse perinatal outcome was defined as composite outcome of IVH, PVL, HIE, NEC, BPD, sepsis or death. RESULTS: Of the 1,116 fetuses with EFWpop<10th centile (Hadlock4), 72% (800) remained <10th centile when adjusted for maternal factors and fetal gender (EFWcust). If customized centiles had been used, 316 (28%) would not have been considered true cases of IUGR. The rate of adverse perinatal outcome was 6.4% (51/800) in those with EFWcust<10th and 2% (6/316) in those with EFWcust>10th centile. This represents a 25% increase in the risk (RR¼1.25) of detecting an adverse outcome using customized centiles compared with standard population centiles. When applying customized centiles to actual birthweights (BW), 64% (714) infants in the overall cohort had a BW <10th customized centile, compared to 72% (796) with BW <10th centile using population norms. CONCLUSION: Results of this large prospective study validate the usefulness of fetal weight customization for the most appropriate identification of fetal growth restriction in the antenatal setting.
Poster Session I
Galway, Ireland, 10Graduate Entry Medical School, University of Limerick, Obstetrics & Gynecology, Limerick, Ireland
OBJECTIVE: The aim of the Prospective Observational Trial to Opti-
mize Pediatric Health in IUGR (PORTO) Study was to evaluate the optimal management of fetuses with EFW<10th centile. The objective of this secondary analysis was to describe the growth dynamics of fetuses outgrowing the 10th centile with respect to perinatal outcomes and maternal risk factors. STUDY DESIGN: Over 1,100 consecutive ultrasound-dated singleton pregnancies with EFW<10th centile were subjected to sonographic surveillance at least every two weeks with biometry and multi-vessel Doppler assessment at each visit. Delivery and perinatal outcomes were recorded for each pregnancy. This particular analysis focused on ‘Growers’, defined as fetuses crossing the threshold for IUGR definition >10th centile as opposed to ‘Showers’, fetuses who remained <10th centile until delivery. RESULTS: Of the 1,116 recruited IUGR fetuses, 193 (17%) subsequently had an EFW>10th centile on their last sonogram prior to delivery confirmed by birthweight >10th centile. The mean GA at enrollment was 28.6+/-4.0 weeks. As outlined in figure 1, outgrowing the 10th centile was a gradual process with considerable variation from fetus to fetus. 61 (32%) crossed the 10th centile by 32 weeks, 56 (29%) between 32 and 36 weeks and 75 (39%) after 36 weeks. The majority of ‘Growers’ (82%; 159/193) remained >10th centile for all subsequent scans. Mothers of ‘Growers’ were less likely to be smokers (14% vs 25%; p<0.001) or affected by hypertensive pregnancy complications (2% vs 11%; p<0.001). 49 (25%) had an abnormal UA Doppler after enrollment, however in the majority of cases (67%; 33/49) this was a single event. There was only one adverse outcome among the 193 infants, a case of sepsis at 37 weeks. CONCLUSION: There are dynamic growth changes in IUGR fetuses with 17% outgrowing their original diagnosis. Positive growth spurts in utero more commonly occur in healthy mothers. Once a fetus has outgrown the 10th centile, consideration could be given to decreasing antenatal surveillance.
98 Intrauterine growth restrictioneare you a grower or a shower? Fiona Cody1, Julia Unterscheider2, Patrick Dicker3, Elizabeth Tully2, Sean Daly4, Michael Geary1, Mairead Kennelly5, Fionnuala McAuliffe6, Keelin O’Donoghue7, Alsyon Hunter8, John Morrison9, Gerard Burke10, Fergal Malone2 1 Rotunda Hospital, Obstetrics & Gynecology, Dublin, Ireland, 2Royal College of Surgeons in Ireland, Obstetrics & Gynecology, Dublin, Ireland, 3Royal College of Surgeons in Ireland, Epidemiology & Public Health, Dublin, Ireland, 4Coombe Women and Infants University Hospital, Obstetrics & Gynecology, Dublin, Ireland, 5UCD Center for Human Reproduction, Coombe Women and Infants University Hospital, Obstetrics & Gynecology, Dublin, Ireland, 6UCD School of Medicine and Medical Science, National Maternity Hospital, Obstetrics & Gynecology, Dublin, Ireland, 7University College Cork, Cork University Maternity Hospital, Obstetrics & Gynecology, Cork, Ireland, 8Royal Jubilee Maternity Hospital, Obstetrics & Gynecology, Belfast, Ireland, 9National University of Ireland, Obstetrics & Gynecology,
99 Uterine artery Doppler at IUGR diagnosisecan it predict adverse perinatal outcome? Julia Unterscheider1, Keelin O’Donoghue2, Sean Daly3, Michael Geary4, Mairead Kennelly5, Fionnuala McAuliffe6, Alyson Hunter7, John Morrison8, Gerard Burke9, Patrick Dicker10, Elizabeth Tully1, Fergal Malone1
Supplement to JANUARY 2014 American Journal of Obstetrics & Gynecology
S63
Poster Session I
Ultrasound, Fetus, Genetics
1
Royal College of Surgeons in Ireland, Obstetrics & Gynecology, Dublin, Ireland, 2University College Cork, Cork University Maternity Hospital, Obstetrics & Gynecology, Cork, Ireland, 3Coombe Women and Infants University Hospital, Obstetrics & Gynecology, Dublin, Ireland, 4Rotunda Hospital, Obstetrics & Gynecology, Dublin, Ireland, 5UCD Center for Human Reproduction, Coombe Women and Infants University Hospital, Obstetrics & Gynecology, Dublin, Ireland, 6UCD School of Medicine and Medical Science, National Maternity Hospital, Obstetrics & Gynecology, Dublin, Ireland, 7 Royal Jubilee Maternity Hospital, Obstetrics & Gynecology, Belfast, Ireland, 8 National University of Ireland, Obstetrics & Gynecology, Galway, Ireland, 9 Graduate Entry Medical School, University of Limerick, Obstetrics & Gynecology, Limerick, Ireland, 10Royal College of Surgeons in Ireland, Epidemiology & Public Health, Dublin, Ireland
OBJECTIVE: The aim of the Prospective Observational Trial to Optimize Pediatric Health in IUGR (PORTO) Study was to evaluate the optimal management of fetuses with EFW<10th centile. The objective of this secondary analysis was to establish whether an abnormal uterine artery (UtA) Doppler at IUGR diagnosis can be utilized to predict subsequent adverse perinatal outcome. STUDY DESIGN: Over 1,100 consecutive ultrasound-dated singleton pregnancies with EFW<10th centile were subjected to sonographic surveillance at least every two weeks with biometry and multi-vessel Doppler assessment at each visit. Uterine artery Doppler was recorded once at enrollment to the study. Adverse perinatal outcome was defined as composite outcome consisting of intraventricular hemorrhage, periventricular leucomalacia, hypoxic ischemic encephalopathy, necrotizing enterocolitis, bronchopulmonary dysplasia, sepsis or death. Comparisons were performed using Fisher’s exact test and p<0.05 was considered significant. RESULTS: Of the 1,116 pregnancies completing the study protocol, 823 (74%) had uterine artery Doppler assessment at enrollment (mean GA 31 weeks; IQR¼28-34 weeks). Abnormal uterine artery Doppler, defined as either presence of notching or UtA pulsatility index (PI) >95th centile was observed in 26% (n¼214) cases. Uterine artery abnormalities identified 58% (n¼25) of adverse perinatal outcomes (Table 1) and 66% (n¼53) of IUGR pregnancies complicated by pre-eclampsia. The sensitivity for predicting adverse perinatal outcome by UtA Doppler alone was 58%. The negative predictive value (NPV) of UtA Doppler was 97%. CONCLUSION: Abnormal uterine artery Doppler at IUGR diagnosis is strongly associated with adverse perinatal outcome and preeclamptic pregnancy complications. If the uterine artery Doppler is normal at IUGR diagnosis, the risk of adverse outcome is very small. Therefore UtA Doppler evaluation could be incorporated into the risk stratification of IUGR pregnancies at diagnosis, even in the late second and third trimester.
Abnormal uterine artery Doppler and adverse perinatal outcome
www.AJOG.org
100 Clinical significance of placental lesions in IUGReresults from a national prospective study Julia Unterscheider1, Emma Doyle2, Deirdre Devaney2, Brendan Fitzgerald3, Keelin O’Donoghue4, Sean Daly5, Michael Geary6, Mairead Kennelly7, Fionnuala McAuliffe8, Alyson Hunter9, John Morrison10, Gerard Burke11, Patrick Dicker12, Elizabeth Tully1, Fergal Malone1 1 Royal College of Surgeons in Ireland, Obstetrics & Gynecology, Dublin, Ireland, 2Rotunda Hospital, Pathology, Dublin, Ireland, 3Cork University Hospital, Pathology, Cork, Ireland, 4University College Cork, Cork University Maternity Hospital, Obstetrics & Gynecology, Cork, Ireland, 5Coombe Women and Infants University Hospital, Obstetrics & Gynecology, Dublin, Ireland, 6Rotunda Hospital, Obstetrics & Gynecology, Dublin, Ireland, 7UCD Center for Human Reproduction, Coombe Women and Infants University Hospital, Obstetrics & Gynecology, Dublin, Ireland, 8UCD School of Medicine and Medical Science, National Maternity Hospital, Obstetrics & Gynecology, Dublin, Ireland, 9Royal Jubilee Maternity Hospital, Obstetrics & Gynecology, Belfast, Ireland, 10National University of Ireland, Obstetrics & Gynecology, Galway, Ireland, 11Graduate Entry Medical School, University of Limerick, Obstetrics & Gynecology, Limerick, Ireland, 12 Royal College of Surgeons in Ireland, Epidemiology & Public Health, Dublin, Ireland
OBJECTIVE: The aim of the Prospective Observational Trial to Opti-
mize Pediatric Health in IUGR (PORTO) Study was to evaluate the optimal management of fetuses with EFW<10th centile. The objective of this analysis was to identify clinical and placental pathological features in fetuses with EFW<10th centile that distinguish those affected by adverse perinatal outcomes from unaffected fetuses. STUDY DESIGN: The multicenter PORTO Study recruited 1,200 pregnancies with EFW<10th and subjected them to intensive antenatal sonographic surveillance. Adverse perinatal outcome was defined as composite outcome of IVH, PVL, HIE, NEC, BPD, sepsis or death. Placentas from a single center were included to ensure uniform handling and reporting. Placental pathology was categorized into villous development abnormalities, maternal and fetal vascular pathologies and inflammatory lesions. RESULTS: Of the 260 placentas evaluated in this single center, 72% (n¼187) of fetuses remained <10th centile until delivery. Infants with adverse outcome were delivered significantly earlier resulting in lower birthweights (p<0.0001). The earlier delivery was precipitated by the clinical severity of IUGR (p<0.0001). Placentas of infants with adverse outcome were smaller with increased placental/ birthweight ratio (p<0.001), both of which relate to earlier gestation at delivery. The occurrence of nucleated erythroblasts as a sign of intrauterine hypoxia was significantly more common in the adverse outcome group (p¼0.0001). Other placental findings significantly associated with adverse outcome after multivariate analysis adjusting for gestational age at delivery were accelerated villous maturation, distal villous hypoplasia and increased syncytial knotting (Table 1). CONCLUSION: Adverse perinatal outcome in IUGR is significantly associated with earlier gestation at delivery, severity of IUGR, UA Doppler abnormalities, placental evidence of intrauterine fetal hypoxia and alterations in placental villous development.
*Fisher exact test; significance level p<0.05.
S64 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2014