Objectives-The purpose of this study was to evaluate the end-diastolic size and shape of the 4-chamber view as well as the right ventricle (RV) and left ventricle (LV) in growth-restricted fetuses before 34 weeks' gestation with absent or reversed end-diastolic velocity of the umbilical artery and compare the results between those with perinatal deaths and those who survived the neonatal period.Methods-Forty-nine fetuses with growth restriction and absent or reversed end-diastolic velocity of the umbilical artery were studied. The size, shape, and sphericity index of the 4-chamber view, RV, and LV were assessed. The number and percentage of fetuses with z score values of less than −1.65 and greater than 1.65 were computed.Results-Of the 49 fetuses, there were 13 perinatal deaths (27%) and 36 (63%) neonatal survivors. Measurements that were unique for neonatal survivors were an increased RV apical transverse width and decreased measurements of the following: LV and RV widths, LV and RV areas, as well as RV sphericity indices.Conclusions-Fetuses with a smaller RV and LV size and area and those with a globular-shaped RV were at significantly lower risk for perinatal death.Key Words-absent umbilical artery diastolic flow; cardiomegaly; fetal death; fetal echocardiography; fetal growth restriction; global sphericity index; perinatal death; speckle tracking I n a recent meta-analysis of 31 studies evaluating 336 fetal deaths in growth-restricted fetuses before 34 weeks' gestation who had absent or reversed end-diastolic flow of the umbilical artery (UA), ductus venosus (DV), or both, the authors reported odds ratios for fetal death of 6.8 for absent or reversed enddiastolic velocity (AREDV) of the UA and 11.6 for absent or reversed flow of the DV. 1 Since AREDV is associated with increased placental resistance to blood flow, resulting in an

OBJECTIVE: SMFM Consult Series (#46) on polyhydramnios (PH) recommends that "antenatal fetal surveillance (AFS) is not required for the sole indication of mild idiopathic" PH. A corollary is that AFS may be considered for moderate-severe (MS) PH. The objective of this study was to determine the cutoff for deepest vertical pocket (DVP) which correlates with amniotic fluid index (AFI) > 30 cm (i.e. MS PH) to guide those who utilize DVP over AFI. STUDY DESIGN: This retrospective study of 3rd trimester ultrasounds at 17 academically affiliated units included singletons with AFI and DVP. The study population was randomly divided into testing and validation groups. In the testing group, DVP thresholds correlating with AFI > 30 cm were calculated in two ways: i) a receiver operating curve and Youden's J statistic (DVP-Youden) and ii) calculation of the DVP percentile that corresponded with an AFI of 30.0 (DVP-Percentile). Using the validation group, test performance was calculated for DVP-SMFM, DVP-Youden, and DVP-Percentile for diagnosis of AFI > 30 cm. RESULTS: From the 71,893 ultrasounds in the study period, the test group was 23,965 (33%) and the validation group 47,928 (67%). MS PH occurred in 286 (1.2%) in test group and 571 (1.2%) in validation group. An AFI of 30 cm corresponded to the 98.9 percentile and with DVP-Percentile, 10 cm. The calculated cutoff for MS PH was 8.0 for DVP-Youden (Figure). Sensitivities of DVP-Youden and DVP-Percentile were significantly higher than DVP-SMFM, but with an increased false positive rate (Table ). In the sensitivity analysis, results were similar among pregnancies without diabetes or anomalies. CONCLUSION: Applying a cutoff of 8.0 cm rather than 12.0 cm increased detection of moderate-severe polyhydramnios to 100% with a false positive rate under 5%. If the SMFM DVP threshold of