Poster Session II
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Relationships of abnormal MCA and CPR with selected outcomes
are shown (table). These relationships were unchanged when the
SGA neonates were excluded from analysis: normal BW babies with
abnormal fetal cerebral Doppler findings had increased adverse
outcome. No difference was demonstrated for the other outcome
variables.
CONCLUSION: In this study of fetuses with normal-range EFW, multi-
vessel Doppler cerebral blood flow abnormalities predict NICU
admission, low weight at delivery, and risk of stillbirth. These re-
lationships are true regardless of the EFW category. This data ap-
pears to validate use of multi-vessel Doppler in third trimester
assessment of normal-sized fetuses.
Relationships of abnormal MCA and CPR with selected outcomes in fetuses with normal EFW.
Outcome Abnormal MCA OR (CI) Abnormal CPR OR (CI)
SGA 1.62(0.89-2.92) 2.93(1.56-5.61)
pH<7.1 1.17(0.35-3.90) 1.19(0.28-5.11)
Apgar - 1.28(0.17-9.85)
Stillbirth 12.62(2.76-57.62) 10.20(1.92-54.12)
NICU admission 2.06(1.19-3.58) 2.41(1.26-4.60)
304 Elevated umbilical artery Doppler pulsatility index
and neurodevelopmental outcome in children - secondary
analysis of a 12-year prospective cohort study
Fionnuala Mone1,2, Barbara McConnell3, Andrew Thompson4,
Ricardo Segurado5, Peter Hepper6, Moira C. Stewart4,
James C. Dornan7, Stephen Ong7, Fionnuala M. McAuliffe2,1,
Michael D. Shields8
1
Department of Fetal Medicine, National Maternity Hospital, Dublin, Ireland,
2 RESULTS: Uterine artery Doppler indices, birth weight, and gesta-
UCD Obstetrics and Gynaecology, School of Medicine and Medical Science,
University College Dublin, Dublin, Ireland, 3Department of Early Childhood
Studies, Stranmillis University College, Belfast, United Kingdom, 4Royal
Belfast Hospital for Sick Children, Belfast Health & Social Care Trust, Belfast,
United Kingdom, 5CSTAR, School of Public Health, Physiotherapy and
Population Science, University College Dublin, Dublin, Ireland, 6Department
of Psychology, Queen’s University Belfast, Belfast, United Kingdom,
7
Department of Fetal Medicine, Royal Maternity Hospital, Belfast, United
Kingdom, 8Centre for Infection & Immunity, Queen’s University Belfast,
Belfast, United Kingdom
OBJECTIVE: To determine if an elevated fetal umbilical artery Doppler
(UAD) pulsatility index (PI) assessed at 28 weeks gestation, in the
absence of fetal growth restriction (FGR) and prematurity, is asso-
ciated with adverse neurocognitive outcome in children aged twelve
years.
STUDY DESIGN: Prospective cohort study, comparing children with a
normal fetal UAD PI (<90th centile) (n¼110) and those with an
elevated PI (90th centile) (n¼40). UAD was performed at 28-, 32-
and 34-weeks gestation. At 12 years of age all children were assessed
under standardized conditions in Queen’s University, Belfast, UK to
determine cognitive and behavioural outcomes using the British
Ability Score-II and Achenbach Child Behavioural Checklist Parent
Rated Version under standardized conditions. Regression analysis
was performed which controlled for confounders of gender, socio-
economic status, and age at assessment.
RESULTS: The mean age of follow up was 12.4 years (+/- 0.5 SD) with
44% of children male (n¼63). When UAD was assessed at 28-weeks’
the elevated fetal UAD group had lower scores in cognitive assess-
ments of information processing and memory. Parameters included
(i) Recall of objects immediate verbal (p¼0.002), (ii) delayed verbal
(p¼0.008) and (iii) recall of objects immediate spatial (p¼0.0016).
S174 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2016
ajog.
There were no significant differences between the Doppler groups at
32 or 34 weeks’ gestation.
CONCLUSION: An elevated UAD PI at 28 weeks’ gestation in the
absence of FGR or prematurity is associated with some adverse
cognitive findings in children aged twelve years. A potential expla-
nation for this is an element of placental insufficiency in the presence
of the appropriately grown fetus, which impacts on development of
the fetal hippocampus and information processing and memory
long-term. Further studies should be performed before firm con-
clusions or guidance can be drawn from the findings of this study.
305 Lack of value of uterine artery Doppler screening to
predict fetal growth restriction in nulliparous women
Samuel Parry1
1
For the Eunice Kennedy Shriver National Institute of Child Health and
Human Development NuMoM2b Network, Bethesda, MD
OBJECTIVE: To determine the utility of maternal uterine artery
Doppler studies as a predictor of fetal growth restriction.
STUDY DESIGN: Nulliparous women with a viable singleton pregnancy
were recruited during their first trimester into an observational
cohort study at eight institutions across the United States. Partici-
pants were seen at three study visits during pregnancy and again at
delivery. We assessed whether three indices of uterine artery Doppler
flow (resistance index, pulsatility index, and diastolic notching)
measured between 16.0-22.6 weeks gestation could be used to
accurately predict small birth weight for gestational age <5th
percentile (SGA, Alexander growth curve). Uterine artery Doppler
indices were measured in the right and left uterine arteries, and test
characteristics for varying thresholds were evaluated.
tional age at birth were available for 8,151 women. For 362 (4.4
percent), the neonates were <5th percentile birth weight for gesta-
tional age. Typical thresholds for the uterine artery Doppler indices
were all associated with SGA (p<0.001 for each), but the positive
predictive values were all <10 percent and areas under receiver
operating characteristic curves (AUCs) ranged from 0.54 to 0.59 (see
Table). Over the range of values for each measure in the left and
right uterine arteries, the AUCs ranged from 0.57 to 0.63 (see
Figure). Incorporating maternal age, pre-pregnancy BMI, race/
ethnicity, smoking status prior to pregnancy, chronic hypertension,
and pregestational diabetes in the prediction model resulted in only
modest improvements in the AUCs ranging from 0.63 to 0.67.
CONCLUSION: In this large prospective cohort, second trimester
uterine artery Doppler studies were not a clinically useful screening
test for SGA birth weight.
Uterine artery Doppler test characteristics
Measurement thresholds Sen Spec PPV NPV LR+ LR- AUC
Left RI >0.58 0.62 0.56 0.06 0.97 1.41 0.67 0.59
Right RI >0.58 0.54 0.61 0.06 0.97 1.38 0.76 0.57
Left PI >1.60 0.23 0.88 0.08 0.96 1.97 0.87 0.56
Right PI >1.60 0.22 0.90 0.10 0.96 2.24 0.86 0.56
Left Notch >5 cm 0.33 0.79 0.07 0.96 1.56 0.85 0.56
Right Notch >5 cm 0.23 0.85 0.06 0.96 1.48 0.91 0.54