Correlation of maternal body mass index with umbilical artery Doppler in pregnancies complicated by fetal growth restriction and associated outcomes

Contributions Regarding the Study of Pulsatility and Resistivity Indices of Uterine Arteries in Term Pregnancies-A Prospective Study in Bucharest, Romania

Pregnancy is a complex stage in a woman's life, considering the physical and psychological changes that occur. The introduction of Doppler studies of the pregnant woman's vessels and those of the fetus has proven to be a useful tool in evaluating the maternal-fetal relationship. Objective: The study aims to assess the correlations of PI and RI values in term pregnancies. Methods: This analysis is based on the prospective evaluation of medical data from 60 patients who were admitted to the Obstetrics and Gynecology department of Saint Pantelimon Hospital in Bucharest, Romania, from May to August 2024. Among the examined parameters are patient age, blood pressure, amniotic fluid quantity, placenta location, and pulsatility and resistivity indices of uterine arteries. Results: A higher diastolic blood pressure is associated with higher mean PI and RI values, indicating that diastolic blood pressure has a significant correlation to these values. The mean RI shows a moderately negative and significant correlation, suggesting that a lower level of amniotic fluid is associated with a higher mean RI. Regarding the PI value of the uterine arteries, the p-value suggests that the difference between the groups with and without associated diseases is statistically significant. Placental insertion on the anterior or posterior uterine wall does not have a significant impact on the PI and RI values of the uterine arteries, but the values are higher in the contralateral part of the placental insertion. Conclusions: These results strengthen the evidence previously demonstrated. Uterine artery Doppler ultrasonography is an extremely useful tool in monitoring and managing high-risk pregnancies.

Value of Cerebroplacental Ratio in Predicting Adverse Perinatal Outcome in Term Pregnancies Complicated by Obesity

Objectives

To evaluate the performance of cerebroplacental ratio (CPR) in predicting composite adverse perinatal outcome (CAPO) in women with obesity compared to non-obese women at term.

Methods

This is a retrospective cohort study in a single tertiary referral centre over a 3-year period. All singleton pregnancies with CPR measurements ≥ 37 + 0 weeks and estimated fetal weight ≥ 10 th centile and attempted vaginal delivery were included and divided into two groups defined by pre-pregnancy body mass index (BMI)

Results

The study cohort included 1207 pregnancies, of which 112 were women with a BMI ≥ 30 kg/m 2 . In obese women, CAPO occurred in 21 cases (18.8%) compared to 247 (22.6%) cases in women with BMI < 30 kg/m 2 (p = 0.404). In the entire study cohort, CPR MoM was significantly lower in the CAPO and OD for IFC group. ROC analyses revealed a significant predictive value of low CPR MoM for CAPO in obese women (AUC = 0.64, p = 0.024). Furthermore, CPR was predictive for OD for IFC not only in obese (AUC = 0.72, p = 0.023) but also in non-obese (AUC = 0.61, p = 0.003) women.

Conclusions

Low CPR MoM was predictive for CAPO and OD for IFC in obese women without additional risk factors. However, the overall predictive performance of CPR for CAPO in obese women was poor.

Collapse

Key Words

• BMI
• adverse perinatal outcome
• cerebroplacental ratio
• obesity

Collapse

MESH Headings Collapse

Grants Collapse

Affiliation(s)

Gabriel Eisenkolb Department of Gynecology and Obstetrics, TUM School of Medicine and Health, Technical University Munich (TUM), TUM University Hospital, Munich, Germany
Anne Karge Department of Gynecology and Obstetrics, TUM School of Medicine and Health, Technical University Munich (TUM), TUM University Hospital, Munich, Germany
Javier U. Ortiz Department of Gynecology and Obstetrics, TUM School of Medicine and Health, Technical University Munich (TUM), TUM University Hospital, Munich, Germany
Eva Ostermayer Department of Gynecology and Obstetrics, TUM School of Medicine and Health, Technical University Munich (TUM), TUM University Hospital, Munich, Germany
Silvia M. Lobmaier Department of Gynecology and Obstetrics, TUM School of Medicine and Health, Technical University Munich (TUM), TUM University Hospital, Munich, Germany
Bettina Kuschel Department of Gynecology and Obstetrics, TUM School of Medicine and Health, Technical University Munich (TUM), TUM University Hospital, Munich, Germany
Oliver Graupner Department of Gynecology and Obstetrics, TUM School of Medicine and Health, Technical University Munich (TUM), TUM University Hospital, Munich, Germany

Collapse

Relationship between kisspeptin levels in the third trimester and late-onset fetal growth restriction: A case-control study

INTRODUCTION

We aimed to investigate whether maternal serum kisspeptin levels are associated with late-onset FGR and contribute to adverse perinatal outcomes.

METHOD

In this case-control study, a total of 90 pregnant women admitted to the perinatology clinic were enrolled. Forty-five of them were diagnosed with FGR and 45 women with healthy pregnancies formed the control group. Maternal serum levels of kisspeptin 1 were compared.

RESULTS

Median kisspeptin1 serum levels were higher in the group of patients with FGR according to gestational age than in the control group [79.4(3.9-230.2) pg/mL vs. 39.8(0.4-188.3) pg/mL; p = 0.001]. The optimal cut-off value for kisspeptin1 was 30.32 pg/mL, with a positive predictive value of 64.6% (95% CI; 0.54-0.86), negative predictive value of 87.5% (95% CI; 0.44-0.72), positive likelihood ratio 1.75 (95% CI; 1.31-2.32), negative likelihood ratio 0.14 (95% CI; 0.04-0.44).

DISCUSSION

Kisspeptin1 differed significantly in late-onset FGR compared with the control group. This difference from the control group can be used to estimate late-onset FGR.

Dynamic growth changes in fetal growth restriction using serial ultrasonographic biometry and umbilical artery doppler: The multicenter PORTO study

OBJECTIVE

To describe the growth dynamics of fetuses with initial fetal growth restriction (FGR) later outgrowing the 10th centile for estimated fetal weight with respect to perinatal outcomes and maternal factors.

METHODS

A multicenter prospective study recruited 1116 patients for ultrasound surveillance between 2010 and 2012. All pregnancies were growth-restricted singleton gestations between 24 + 0 and 36 + 0 weeks. Biometry and Doppler analysis were carried out, and delivery and adverse perinatal outcomes were recorded.

RESULTS

A total of 193 (17%) fetuses outgrew their diagnosis of initial FGR (surpassed the 10th centile) on their last sonogram before delivery. These fetuses were termed "growers," to compare with the true FGR group. The mothers of "growers" were less likely to be smokers (14% vs 25%, P = 0.0001) or affected by hypertensive pregnancy complications (5.2% vs 15%, P = 0.001). Of the growers, 49 (25%) had an abnormal umbilical artery Doppler; however, in most cases (33/49, 67%), this was a single episode of raised umbilical artery pulsatility index, which subsequently normalized.

CONCLUSION

There were dynamic growth changes in FGR fetuses, with 17% outgrowing their original diagnosis. Positive growth spurts more commonly occurred in healthy mothers. Once a fetus had outgrown the 10th centile, antenatal surveillance could be decreased.