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Objective To identify independent predictors of adverse neonatal outcome in cases of fetal growth restriction (FGR) at ≥34 weeks. Methods From a cohort of 481 FGR cases delivered at ≥34 weeks, demographic and obstetric variables, fetal biometry and Doppler indices of the uterine, umbilical and fetal middle cerebral arteries available within 2 weeks of delivery, were related to adverse neonatal outcome, defined as admission to the neonatal intensive care unit for indications other than low birth weight alone. Results Logistic regression analysis showed that gestational age (GA) at delivery (odds ratio (OR) = 0.59; 95% CI, 0.50‐0.70), abdominal circumference (AC) centile (OR = 0.69; 95% CI, 0.59‐0.81) and umbilical artery (UA) pulsatility index (PI) centile (OR = 1.02; 95% CI, 1.01‐1.04) significantly correlated with adverse neonatal outcome.From thismodel we calculateda scoreof adverse neonatal outcome expressed by the formula: (UA-PI centile/3) − (10 × AC centile) + (10 × (40 − GA at delivery in weeks)). Receiver‐operating characteristics curve analysis demonstrated that a score of ≥25 optimally predicted adverse neonatal outcome (sensitivity of 75%, falsepositive rate of 18%). Beyond 37.5 weeks, gestational age no longer had an independent impact on outcome. Conclusions In late preterm or term FGR, GA at delivery is the most important predictor of adverse neonatal outcome. At >37.5 weeks, delivery may be the best option to minimize adverse outcome in all FGR cases. At 34‐37 weeks, a score based on GA at delivery, UA-PI centile and AC centile optimally predicts adverse neonatal outcome. Copyright  2010 ISUOG. Published by John Wiley & Sons, Ltd.

Objective: The aim of this retrospective study was to assess the role of uterine artery (UtA) Doppler velocimetry in the prediction of small for gestational age (SGA) fetuses in a high risk population. Methods: A population of 145 singleton high risk pregnancies was evaluated with serial UtA Doppler performed within 23 weeks (I UtADoppler) and between 23 and 30 weeks’ gestation (II UtA Doppler). Risk population was composed by women with chronic hypertension or with a previous pregnancy complicated by one of the following: preeclampsia, stillbirth, abruptio placentae, small for gestational age newborns. The association between an abnormal UtA velocimetry (Resistance Index > 0.58 and/or bilateral notch) and the probability to develop SGA fetuses was analysed. SGA fetuses were diagnosed on the base of ultrasonographic measurement of abdominal circumference below the 10 centile. Therapy with low-dose aspirin and/or Low Weight Molecular Heparin was prescribed according with a clinical protocol. Results: Gestational age at delivery, mean birth weight, abnormal UtA Doppler and Umbilical artery Doppler were significantly different between SGA fetuses and not SGA fetuses (Table 1). Particularly 30% of SGA fetuses with an abnormal UtA Doppler had also an abnormal Umbilical artery Doppler (defined as a Pulsatility Index >95 centile). Logistic regression analysis showed that only the abnormal UtA Doppler test performed between 23 and 30 weeks’ gestation independently correlated with SGA fetuses, otherwise ASA was a significant protective factor for SGA fetuses (Table 2). Persistence of abnormal UtA Doppler was associated with a statistically higher rate of SGA. Conclusion: An abnormal UtA Doppler in the late second or early third trimester remained the variable significantly related with SGA fetuses; therefore UtA Doppler evaluation between 23 and 30 weeks could be useful for the management of high risk population. ASA was a significant protective factor for intrauterine growth.

Objective To assess the role of uterine artery (UtA) Doppler to predict superimposed preeclampsia in women with chronic hypertension. Methods In a cohort of 182 women with chronic hypertension, UtA Doppler studies were performed before 25 weeks (mean 19.7 ± 2.1 weeks) and repeated later in pregnancy (mean 28.5 ± 3.7 weeks). Results The incidence of preeclampsia was 13% (24/182). Rates of preeclampsia increased with advancing gestation of abnormal UtA Doppler: 7% when UtA Doppler were normal at early exam, 18% when abnormal at early exam, and 28% when abnormal at late exam (Chi-square for trend: P < 0.001). The rate of preeclampsia among 40 women with abnormal early but normal late UtA Doppler was similar to that of women with normal findings at early exam (8 vs 7%; P = 1.00). Logistic regression analysis showed that the ability of UtA Doppler to predict preeclampsia was independent from other variables [Odds Ratio (OR) 7.1, 95% Confidence Interval (CI) 2.6–18.9). Receiver operating characteristic (ROC) curve identified a UtA value of 0.58 as the optimal threshold for the prediction of preeclampsia. Conclusion The later in pregnancy the abnormal UtA Doppler findings are observed, the greater the risk of preeclampsia. Normalization of UtA Doppler after 25 weeks reduces the risk of preeclampsia to 8%. Copyright © 2008 John Wiley & Sons, Ltd.