RCOG World Congress 2023

Uterine artery doppler: A predictor of abnormal foetal growth in high-risk pregnancies

Objective: To assess the pick up rate of foetal growth restriction (FGR) and small for gestation age (SGA) with mid-trimester uterine artery doppler (UtAD).

Importance:

•SGA is associated with increased morbidity & mortality – identification antenatally can reduce this by optimising timing of delivery

•Up to 20% of SGA can be contributed to FGR,chromosomal or structural abnormalities or infection

•In a high risk population, mid-trimester UtAD has a moderate predictive value for SGA (20-24/40)

•Element 2 of Saving Babies Lives suggests FGR is the biggest risk factor for stillbirth and that the majority of FGR cases are associated with abnormal UAD indices or estimated fetal weight (EFW) <10th centile in 3rdtrimester

Design & Method:

•Retrospective audit spanning 12 months at Worcester Acute Hospitals

•The standard used was our local guideline, based on Saving Babies Lives Care Bundle V2

•Those identified as at risk of SGA or FGR, assessed by the bundle, were invited for a mid-trimester UtAD à N = 333

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High risk included:

•Maternal comorbidities

•Obstetric History: previous FGR, previous SGA stillbirth, previous hypertensive disease of pregnancy

•Current pregnancy: estimated foetal weight (EFW) <10th centile, PAPP-A <5th centile, echogenic bowel, significant bleeding

Results:

Those with abnormal UAD (presence of notching or raised PI) started serial growth and umbilical artery doppler (UAD) monitoring from 28/40. Normal UAD commenced serial growth +/- UAD from 32/40

•83.5 % had normal mid-trimester UtAD, 10.2% had abnormal results

•40% of all high risk babies scanned were measuring SGA or FGR on ultrasound scan

•22% of all high risk babies were SGA or FGR at delivery

•12% of all SGA/FGR had abnormal UtAD

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•6.3% were unable to be completed and therefore treated as high risk with serial sonography from 28/40. These were all due to raised BMI. 24% of this group were SGA or FGR

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•29% of women had an extra foetal surveillance scan at 28/40 despite normal mid-trimester UAD results

Conclusion & Clinical Implication:

•A normal mid-trimester UtAD is unlikely to result in FGR.

•BMI is a significant risk factor

•Identification of abnormal UtADallows increased surveillance and optimisation of care, including timing of delivery

•Following an algorithm or pathway to ensure appropriate timing of serial growth scans will reduce unnecessary scanning and reduce ultrasound demands and costs

•Regular service review needs to take place, with the focus on capacity & training.

RCOG World Congress 2023

Uterine artery doppler: A predictor of abnormal foetal growth in high-risk pregnancies

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