Longitudinal Doppler assessment and perinatal outcomes in early-set intrauterine growth restriction fetuses

The objective of this study is to evaluate, in fetuses with early-onset fetal growth-restricted (FGR) requiring delivery before 30 weeks, the relationship between the longitudinal Doppler changes and severe morbidity and mortality.

A retrospective cohort was constructed of singleton pregnancies between January 2013 and December 2021 with antenatal suspicion of FGR, born before 30 weeks in a single tertiary center in Barcelona (Hospital Sant Joan de Déu and Hospital Clínic). A total of 103 cases of FGR fetuses were included. Accurate anatomical examination, fetal biometry, and prenatal Doppler ultrasound examination were performed by experienced operators. The association between the intervals from diagnosis to abnormal Doppler and severe adverse outcome was evaluated with Cox and logistic regression, adjusted for gestational age at onset and preeclampsia. The primary outcome was a composite of severe adverse outcomes defined as mortality or severe neurological morbidity.

Among the 83 pregnancies with ductus venosus (DV) pulsatility index (PI) ≤95th centile at admission, the median time to a DV PI >95th centile was 16 days in pregnancies presenting severe adverse outcomes and 20 days in those without (p = 0.007). Among the 64 pregnancies with a positive umbilical artery (UA) end-diastolic velocity (EDV), the median time to be absent/reversed was 11 days in pregnancies presenting severe adverse outcome and 14 days in those without (p = 0.016). Among the 86 pregnancies with nonreversed UA EDV, the median time to reversed flow was 18 days in pregnancies destined to present severe outcomes and 26 days in those without (p = 0.001).

The prediction of mortality or severe morbidity could be better achieved with longitudinal Doppler assessment in FGR fetuses born before 30 weeks.