EP08.23: Speckle tracking echocardiography in fetuses at risk for late‐onset FGR: can we discriminate SGA and FGR and predict the progression from SGA to FGR?

To evaluate the role of speckle tracking echocardiography (STE) in discriminating between small-for-gestational age (SGA) and fetal growth restriction (FGR) and predicting the progression from SGA to FGR within a selected cohort of fetuses at risk for late-onset FGR. Multicentre prospective study including non-anomalous singleton pregnancies with suspected late-onset FGR as defined by abdominal circumference (AC) or estimated fetal weight (EFW) below the 10th percentile for the gestation or by a reduction of the longitudinal growth of the AC by over 50 percentiles compared to second trimester anomaly scan. Two-dimensional ultrasound clips of the four-chamber view of the fetal heart were prospectively collected, and offline STE was performed using TomTec GmbH by one dedicated operator. A cross-sectional comparison of the fetal cardiac function as evaluated by means of STE was performed between SGA and FGR fetuses and then among fetuses classified as SGA and FGR throughout monitoring and those initially classified as SGA but evolving into FGR according to the Delphi criteria. 92 cases were included, of whom 62 FGR at delivery; 30 (32.6%) cases were SGA and 29 (31.5%) throughout monitoring, respectively, and 33 (35.9%) evolved as FGR from initial SGA. At paired comparison FGR fetuses showed lower right ventricular (RV) GRS compared to SGA fetuses (19.6##+12.1 vs 23.1##+13.1, p = 0.04). When comparing the fetuses classified as SGA, FGR or evolving FGR, the latter showed higher RVGRS compared SGA (24.5##+12.9 vs 19.0##+12.3, p < 0.01) and also compared to FGR (24.5##+12.9 vs 19.3##+12.0, p < 0.01). No difference in STE parameters were noted between SGA and FGR. Findings from this study show differences in terms of right ventricular strain between SGA, FGR and evolving FGR suggesting and increased cardiac deformation in the latter group.