PURPOSE: To assess the longitudinal variation of the ratio of umbilical and cerebral artery pulsatility index (UCR) in late preterm fetal growth restriction (FGR). MATERIALS AND METHODS: A prospective European multicenter observational study included women with a singleton pregnancy, 32+ 0-36+ 6, at risk of FGR (estimated fetal weight [EFW] or abdominal circumference [AC] < 10th percentile, abnormal arterial Doppler or fall in AC from 20-week scan of > 40 percentile points). The primary outcome was a composite of abnormal condition at birth or major neonatal morbidity. UCR was categorized as normal (< 0.9) or abnormal (≥ 0.9). UCR was assessed by gestational age at measurement interval to delivery, and by individual linear regression coefficient in women with two or more measurements. RESULTS: 856 women had 2770 measurements; 696 (81 %) had more than one measurement (median 3 (IQR 2-4). At inclusion, 63 (7 %) a UCR ≥ 0.9. These delivered earlier and had a lower birth weight and higher incidence of adverse outcome (30 % vs. 9 %, relative risk 3.2; 95 %CI 2.1-5.0) than women with a normal UCR at inclusion. Repeated measurements after an abnormal UCR at inclusion were abnormal again in 67 % (95 %CI 55-80), but after a normal UCR the chance of finding an abnormal UCR was 6 % (95 %CI 5-7 %). The risk of composite adverse outcome was similar using the first or subsequent UCR values. CONCLUSION: An abnormal UCR is likely to be abnormal again at a later measurement, while after a normal UCR the chance of an abnormal UCR is 5-7 % when repeated weekly. Repeated measurements do not predict outcome better than the first measurement, most likely due to the most compromised fetuses being delivered after an abnormal UCR.

Center for Fetal Medicine Karolinska University Hospital Stockholm Sweden

Department of Gynecology and Obstetrics UZ Leuven and Department of Regeneration and Development KU Leuven Leuven Belgium

Department of Health Sciences University of Florence Obstetrics and Gynecology Careggi University Hospital Florence Italy

Department of Medicine Surgery and Health Sciences University of Trieste Trieste Italy

Department of Neurosciences Reproductive and Dentistry Sciences University of Naples 'Federico II' Naples Italy

Department of Obstetrics and Fetal Medicine University Medical Centre Hamburg Eppendorf Hamburg Germany

Department of Obstetrics and Gynaecology General University Hospital and 1st Faculty of Medicine Charles University Prague Czech Republic

Department of Obstetrics and Gynaecology University Medical Center Groningen University of Groningen Groningen The Netherlands

Department of Obstetrics and Gynecology Amsterdam University Medical Center University of Amsterdam Amsterdam The Netherlands

Department of Obstetrics and Gynecology Amsterdam University Medical Centers University of Amsterdam location VUMC Amsterdam The Netherlands

Department of Obstetrics and Gynecology ASST Spedali Civili di Brescia and University of Brescia Brescia Italy

Department of Obstetrics and Gynecology Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health Università degli Studi di Milano Milan Italy

Department of Obstetrics and Gynecology Haukeland University Hospital Bergen Norway

Department of Obstetrics and Gynecology Klinikum Rechts Der Isar Technical University of Munich Munich Germany

Department of Obstetrics and Gynecology Medical University of Graz Graz Austria

Department of Obstetrics and Gynecology Medical University of Innsbruck Innsbruck Austria

Department of Obstetrics and Gynecology Stavanger University Hospital Stavanger and Department of Clinical Science University of Bergen Bergen Norway

Department of Obstetrics and Gynecology University Hospital of Bern Bern Switzerland

Department of Obstetrics and Gynecology University of Parma Parma Italy

Department of Obstetrics and Gynecology Vittore Buzzi Children's Hospital University of Milan Milan Italy

Department of Obstetrics Charite Humboldt University Berlin and Clara Angela Foundation Berlin Germany

Department of Pediatric Surgery and Neonatology Lund University Skane University Hospital Lund Sweden

Department of Perinatal Medicine University of Utrecht Utrecht The Netherlands

Department of Surgery Division of Obstetrics and Gynecology Tor Vergata University Policlinico Casilino Hospital Rome Italy

Department of Women's and Children's Health Uppsala University Uppsala Sweden

Faculty of Medicine and Life Sciences Hasselt University Agoralaan Diepenbeek Belgium Department of Obstetrics and Gynaecology Ziekenhuis Oost Limburg Genk and Department Physiology Hasselt University Diepenbeek Belgium

Fetal Medicine Unit Leeds General Infirmary Leeds Teaching Hospitals NHS Trust Leeds UK

Fetal Medicine Unit St George's University Hospitals NHS Foundation Trust and Molecular and Clinical Sciences Research Institute St George's University of London London UK

Fetal Medicine Unit University College London Hospitals NHS Foundation Trust London UK

Institute for Reproductive and Developmental Biology Department of Metabolism Digestion and Reproduction Imperial College London UK

Institute for the Care of Mother and Child Prague Czech Republic and 3rd Medical Faculty Charles University Prague Czech Republic

Queen Charlotte's and Chelsea Hospital Imperial College Healthcare NHS Trust London W12 0HS

School of Clinical Sciences University of Nottingham Division of Obstetrics and Gynaecology Maternity Department City Hospital Nottingham UK

St Olav's Hospital Trondheim Norway

The Princess Alexandra Hospital NHS Trust Harlow UK

UCL Elizabeth Garrett Anderson Institute for Women's Health University College London London UK

Unit of Fetal Medicine and Prenatal Diagnosis Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste Italy

Longitudinal Doppler Assessments in Late Preterm Fetal Growth Restriction

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$a Longitudinale Doppler-Bewertungen bei später fetaler Wachstumsrestriktion / $c B. Mylrea-Foley, H. Wolf, T. Stampalija, C. Lees, Truffle-2 Group, TRUFFLE 2 Authors:, B. Arabin, A. Berger, E. Bergman, A. Bhide, CM. Bilardo, AC. Breeze, J. Brodszki, P. Calda, I. Cetin, E. Cesari, J. Derks, C. Ebbing, E. Ferrazzi, W. Ganzevoort, T. Frusca, SJ. Gordijn, W. Gyselaers, K. Hecher, P. Klaritsch, L. Krofta, P. Lindgren, SM. Lobmaier, N. Marlow, GM. Maruotti, F. Mecacci, K. Myklestad, R. Napolitano, F. Prefumo, L. Raio, J. Richter, RK. Sande, J. Thornton, H. Valensise, GHA. Visser, L. Wee, TRUFFLE-2 GROUP AND COLLABORATING AUTHORS, C. Brezinka, Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria, D. Casagrandi, University College London Hospitals NHS Foundation Trust, London, UK, A. Cerny, Department of Obstetrics and Gynaecology, GeneralUniversity Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic, A. Dall’Asta, Department of Obstetrics and Gynecology, University of Parma, Parma, Italy, R. DeVlieger, Department of Gynecology and Obstetrics, UZ Leuven, Leuven and Department of Regeneration and Development, KU Leuven, Leuven, Belgium, J. Duvekot, Department of Obstetrics and Gynecology, Erasmus Academic Centre Rotterdam, Rotterdam, The Netherlands, T. M. Eggebo, St Olav’s Hospital, Trondheim, Norway, I. Fantasia, Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy, F. Ferrari, Obstetrics & Gynecology, Policlinico University Hospital of Modena, Modena, Italy, N. Fratelli, Department of Obstetrics and Gynecology, ASST Spedali Civili di Brescia and University of Brescia, Brescia, Italy, T. Ghi, Department of Obstetrics and Gynecology, University of Parma, Parma, Italy, O. Graupner, Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany, P. Greimel, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria, C. Hofstaetter, Department of Obstetrics & Gynecology, University Hospital of Bern, Bern, Switzerland, D. Lo Presti, Department of Surgery, Division of Obstetrics and Gynecology, Tor Vergata University, Policlinico Casilino Hospital, Rome, Italy, M. Georg, Helsinki University Central Hospital, Helsinki, Finland, F. Macsali, Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway, K. Marsal, Department of Obstetrics and Gynecology, Lund University, Skåne University Hospital, Lund, Sweden, P. Martinelli, Department of Neurosciences, Reproductive and Dentistry Sciences, University of Naples ‘Federico II’, Naples, Italy, E. Ostermayer, Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany, A. Papageorghiou, Fetal Medicine Unit, St George’s University Hospitals NHS Foundation Trust and Molecular & Clinical Sciences Research Institute, St George’s, University of London, London, UK, R. Peasley, Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK, A. Ramoni, Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria, L. Sarno, Department of Neurosciences, Reproductive and Dentistry Sciences, University of Naples ‘Federico II’, Naples, Italy, L. Seikku, Helsinki University Central Hospital, Helsinki, Finland, S. Simeone, Department of Health Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy, B. Thilaganathan, Fetal Medicine Unit, St George’s University Hospitals NHS Foundation Trust and Molecular & Clinical Sciences Research Institute, St George’s, University of London, London, UK, G. Tiralongo, Department of Surgery, Division of Obstetrics and Gynecology, Tor Vergata University, Policlinico Casilino Hospital, Rome, Italy, A. Valcamonico, Department of Obstetrics and Gynecology, ASST Spedali Civili di Brescia and University of Brescia, Brescia, Italy, C. Van Holsbeke, Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium, A. Vietheer, Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway

246    31

$a Longitudinal Doppler Assessments in Late Preterm Fetal Growth Restriction

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$a PURPOSE: To assess the longitudinal variation of the ratio of umbilical and cerebral artery pulsatility index (UCR) in late preterm fetal growth restriction (FGR). MATERIALS AND METHODS: A prospective European multicenter observational study included women with a singleton pregnancy, 32+ 0-36+ 6, at risk of FGR (estimated fetal weight [EFW] or abdominal circumference [AC] < 10th percentile, abnormal arterial Doppler or fall in AC from 20-week scan of > 40 percentile points). The primary outcome was a composite of abnormal condition at birth or major neonatal morbidity. UCR was categorized as normal (< 0.9) or abnormal (≥ 0.9). UCR was assessed by gestational age at measurement interval to delivery, and by individual linear regression coefficient in women with two or more measurements. RESULTS: 856 women had 2770 measurements; 696 (81 %) had more than one measurement (median 3 (IQR 2-4). At inclusion, 63 (7 %) a UCR ≥ 0.9. These delivered earlier and had a lower birth weight and higher incidence of adverse outcome (30 % vs. 9 %, relative risk 3.2; 95 %CI 2.1-5.0) than women with a normal UCR at inclusion. Repeated measurements after an abnormal UCR at inclusion were abnormal again in 67 % (95 %CI 55-80), but after a normal UCR the chance of finding an abnormal UCR was 6 % (95 %CI 5-7 %). The risk of composite adverse outcome was similar using the first or subsequent UCR values. CONCLUSION: An abnormal UCR is likely to be abnormal again at a later measurement, while after a normal UCR the chance of an abnormal UCR is 5-7 % when repeated weekly. Repeated measurements do not predict outcome better than the first measurement, most likely due to the most compromised fetuses being delivered after an abnormal UCR.

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$a Wolf, Hans $u Department of Obstetrics and Gynecology, Amsterdam University Medical Center (Location AMC), University of Amsterdam, Amsterdam, The Netherlands

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$a Stampalija, Tamara $u Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy $u Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy

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$a Lees, Christoph $u Institute for Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, UK $u Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London W12 0HS $u Department of Gynecology and Obstetrics, UZ Leuven and Department of Regeneration and Development, KU Leuven, Leuven, Belgium

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$a Napolitano, R $u UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK $u Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK

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$a Raio, L $u Department of Obstetrics & Gynecology, University Hospital of Bern, Bern, Switzerland

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$a Wee, L $u The Princess Alexandra Hospital NHS Trust, Harlow, UK

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$a D. Casagrandi, University College London Hospitals NHS Foundation Trust, London, UK

710    2_

$a A. Cerny, Department of Obstetrics and Gynaecology, GeneralUniversity Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic

710    2_

$a A. Dall’Asta, Department of Obstetrics and Gynecology, University of Parma, Parma, Italy

710    2_

$a R. DeVlieger, Department of Gynecology and Obstetrics, UZ Leuven, Leuven and Department of Regeneration and Development, KU Leuven, Leuven, Belgium

710    2_

$a J. Duvekot, Department of Obstetrics and Gynecology, Erasmus Academic Centre Rotterdam, Rotterdam, The Netherlands

710    2_

$a T. M. Eggebo, St Olav’s Hospital, Trondheim, Norway

710    2_

$a I. Fantasia, Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy

710    2_

$a F. Ferrari, Obstetrics & Gynecology, Policlinico University Hospital of Modena, Modena, Italy

710    2_

$a N. Fratelli, Department of Obstetrics and Gynecology, ASST Spedali Civili di Brescia and University of Brescia, Brescia, Italy

710    2_

$a T. Ghi, Department of Obstetrics and Gynecology, University of Parma, Parma, Italy

710    2_

$a O. Graupner, Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany

710    2_

$a P. Greimel, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria

710    2_

$a C. Hofstaetter, Department of Obstetrics & Gynecology, University Hospital of Bern, Bern, Switzerland

710    2_

$a D. Lo Presti, Department of Surgery, Division of Obstetrics and Gynecology, Tor Vergata University, Policlinico Casilino Hospital, Rome, Italy

710    2_

$a M. Georg, Helsinki University Central Hospital, Helsinki, Finland

710    2_

$a F. Macsali, Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway

710    2_

$a K. Marsal, Department of Obstetrics and Gynecology, Lund University, Skåne University Hospital, Lund, Sweden

710    2_

$a P. Martinelli, Department of Neurosciences, Reproductive and Dentistry Sciences, University of Naples ‘Federico II’, Naples, Italy

710    2_

$a E. Ostermayer, Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany

710    2_

$a A. Papageorghiou, Fetal Medicine Unit, St George’s University Hospitals NHS Foundation Trust and Molecular & Clinical Sciences Research Institute, St George’s, University of London, London, UK

710    2_

$a R. Peasley, Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK

710    2_

$a A. Ramoni, Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria

710    2_

$a L. Sarno, Department of Neurosciences, Reproductive and Dentistry Sciences, University of Naples ‘Federico II’, Naples, Italy

710    2_

$a L. Seikku, Helsinki University Central Hospital, Helsinki, Finland

710    2_

$a S. Simeone, Department of Health Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy

710    2_

$a B. Thilaganathan, Fetal Medicine Unit, St George’s University Hospitals NHS Foundation Trust and Molecular & Clinical Sciences Research Institute, St George’s, University of London, London, UK

710    2_

$a G. Tiralongo, Department of Surgery, Division of Obstetrics and Gynecology, Tor Vergata University, Policlinico Casilino Hospital, Rome, Italy

710    2_

$a A. Valcamonico, Department of Obstetrics and Gynecology, ASST Spedali Civili di Brescia and University of Brescia, Brescia, Italy

710    2_

$a C. Van Holsbeke, Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium

710    2_

$a A. Vietheer, Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway

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