OP05.05: Longitudinal Doppler assessment and perinatal outcomes in early‐set intrauterine growth restriction fetuses

To assess the relationship of longitudinal Doppler changes to adverse perinatal outcomes in preterm fetal growth restricted (FGR) infants born before 30 weeks, and whether this longitudinal assessment improves prediction. A cohort was constructed of all singleton pregnancies between January 2013 and December 2021 with antenatal suspicion of FGR, born before 30 weeks. The primary outcome was a composite severe adverse outcome defined as mortality (neonatal death or infant death during the infant follow-up) or severe neurological morbidity, defined as cognitive impairment [Bayley Scales of Infant and Toddler Development third edition (Bayley-III) below 85]; cerebral palsy; hearing loss or visual loss. The association of the intervals from diagnosis to abnormal Doppler to severe adverse outcomes was evaluated with Cox and logistic regressions (adjusted for GA at diagnosis and the presence of pre-eclampsia). A total of 103 pregnancies were included. In the 83 women with normal DV PI at admission, the median time to a PI>95th centile was 20 days in pregnancies destined to present severe outcomes and 16 days in those without severe outcomes (adjusted p = 0.004). In the 64 women with a positive UA end-diastolic velocity, the median time to be absent/reversed was 11 days in pregnancies destined to present severe outcomes and 14 days in those without severe outcomes (adjusted p = 0.016). In the 86 women with non-reversed UA end-diastolic velocity, the median time to reversal was 18 days in pregnancies destined to present severe outcomes and 26 days in those without severe outcomes (adjusted p < 0.001). For DV>95th, UA AEDV and AU REDV, adding the days elapsed from diagnosis to the parameter to become abnormal improved the prediction performance of basal models including only gestational age at diagnosis, pre-eclampsia and the Doppler pattern before delivery. Longitudinal Doppler assessment improves the prediction of mortality or severe morbidity in FGR fetuses born before 30 weeks.