58 - Integrating Antenatal Doppler Velocimetry and Placental Pathology to Stratify Neonatal Risk in Early- and Late-Onset Fetal Growth Restriction

Publication Number: 2055.58

jesus Alvarez-Perez, Hackensack UMC, Hackensack, NJ, United States; Andrew Brofsky, Hackensack Meridian School of Medicine, Nutley, NJ, United States; Kaitlynn Chaljub, Hackensack Meridian School of Medicine, Wayne, NJ, United States; Tara Lozy, Hackensack Meridian School of Medicine, Hackensack, NJ, United States; Soindos Abdah, Hackensack Meridian School of Medicine, Fairview, NJ, United States; Nicole Feigenblum, Hackensack University Medical Center, Hackensack, NJ, United States; Marwa Khalil, Hackensack Meridian School of Medicine, hackensack, NJ, United States

Background: Fetal growth restriction (FGR) arises from chronic fetal hypoxia due to uteroplacental hypoperfusion. Monitoring pregnancies with FGR utilizing antenatal ultrasound and Doppler velocimetry is crucial. However, the predictive value of specific markers like Middle Cerebral Artery (MCA) Doppler flow and their correlation with the histo-pathology of the placenta, such as thrombotic vasculopathy, thrombosis, fibromuscular hyperplasia, villous/perivillous thrombosis, fibrosis, and infarcts, is not well established

Objective: Identify neonatal complications associated with sonographic markers and histo-pathology of the placenta. We also aimed to determine how the timing of FGR diagnosis (early-onset at < 32 weeks vs. late-onset at ≥ 32 weeks) modifies these associations.

Design/Methods: A retrospective chart review of SGA neonates was performed with a review of corresponding antenatal sonogram reports. Pregnancies affected by known chromosomal abnormalities were excluded. Bivariate analyses were performed to identify associations between ultrasound findings, the histopathological presence associated with placental insufficiency & postnatal neonatal complications.

Results: Antenatal FGR was diagnosed in 242 SGA neonates, of which 39.2% were diagnosed at < 32 weeks GA. Early diagnosis of FGR was associated with a higher incidence of abnormal MCA Doppler PI (24.7% vs. 20.3%, p=.03), echogenic bowel (30.9% vs. 16.0%, p=.02). 203 neonates had placental histological analysis, of those, 111 (54.7%) had an abnormal histo-pathological placental finding.. When stratified, neonates with placental histo-pathology and early-onset FGR ( < 32 weeks) had significantly higher rates of respiratory distress (56.5% vs. 7.8%, p<.0001), feeding complications (76.1% vs. 42.2%, p=.0004), and a markedly longer median length of stay (25 vs. 3 days, p<.0001). In contrast, those with late-onset FGR (≥ 32 weeks) and placental histo-pathology had a significantly higher incidence of polycythemia (36.0% vs. 10.8%, p=.02). While an isolated abnormal MCA PI was not a significant predictor of adverse neonatal outcomes, its combination with echogenic bowel was predictive of GI complications (p=.03)

Conclusion(s): Early and late-onset FGR exhibit different clinical risk profiles. Early-onset FGR is associated with more severe conditions and morbidities of prematurity, while late-onset FGR is linked to polycythemia. This study emphasizes the need for integrating antenatal findings with a postnatal histological analysis of the placenta which provides a more robust framework for risk stratification and prenatal counseling than any single parameter alone.