PurposeTo evaluate the merit of umbilical artery Doppler study as a predictive marker of perinatal outcome in preterm small for gestational age (SGA) infants.Materials and MethodsA total of 218 patients at 27 - 36 weeks of gestational age (GA) who received antenatal umbilical artery Doppler velocimetry and delivered singleton infants with SGA. The ratio of peak-systolic to end-diastolic blood flow velocities (S/D) in the umbilical artery was measured in each patient. The patients were divided into 3 groups: the normal group with S/D ratios of less than 95th percentile (n = 134), elevated S/D ratio group of 95th or more percentile (n = 41), and those with absent/reversed end diastolic flow (n = 43). Maternal characteristics and neonatal outcomes of these groups were comparatively analyzed.ResultsThe gestational age (GA) at the time of diagnosis of SGA, the mean GA at delivery, and the mean birth weight showed statistically significant difference among three groups (p < 0.001). Also, poor perinatal outcome was significantly increased in infants with abnormal S/D ratio (13.4% vs. 31.7% vs. 67.4%, p < 0.001). Multivariate logistic regression analysis revealed umbilical artery Doppler study as a significant independent factor for prediction of poor perinatal outcome (odds ratio: 3.7, 95% confidence interval 1.4 - 9.5, p = 0.007).ConclusionAntenatal umbilical artery Doppler velocimetry is shown as a significantly efficient marker in predicting perinatal outcome in preterm SGA infants.

Objectives: Fetal kidney produces amniotic fluid and it is crucial for the fetal and development maturation. To evaluate fetal renal function by analyzing the hemodynamics of fetal renal artery and the renal volume, we have measured them in normal fetuses after 20 weeks of gestation using the color Doppler and 3D sonography. Methods: After obtaining informed consent from 66 pregnant women with healthy fetuses, the following investigations were performed every 4 weeks after 20 weeks of gestation.: (1) Hemodynamic analysis: maximum systolic velocity (Vmax), mean velocity (Vmean), minimal velocity (Vmin), arterial cross sectional area (Area), resistance index (RI) and pulsatility index (PI) of the fetal renal artery (2) Fetal renal volume. Results: All hemodynamic indexes except RI and PI increased significantly with the course of pregnancy. Vmax, Vmean and area of the renal artery increased significantly from 21.80 ± 0.40 cm/s, 9.56 ± 0.17 cm/s and 6.78 ± 0.25 mm 2 at 20-24 weeks to 41.59 ± 0.46, 20.15 ± 0.22 and 10.12 ± 0.19 at 37-40 weeks, respectively (P < 0.05). Renal Volume of the fetal kidney also increased significantly between the 20-24 weeks and the 37-40 weeks (1.375 ± 1.41 mm 2 vs. 11.21 ± 1.63 mm 2 , P < 0.003). Conclusions:We have clarified the changes of fetal renal hemodynamic indexes and the fetal renal volume during the normal course of pregnancy. These indices might be used for the evaluation of fetal renal function in the near future. P46.03How can we recognize the very early stage of brain sparing effect?A. Surányi 1 , A. Keresztúri 1 , T. Nyári 2 , A. Pál 1 Department of Obstetrics and Gynaecology of Szeged University, Hungary, 2 Department of Medical Informatics of Szeged University, HungaryBackground: The object of this study was to investigate the fetal renal and middle cerebral arterial blood flows in normal and hyperechogenic kidneys during the fetal period. Materials and methods: Study group consisted of 82 pregnancies with intrauterine growth retardation. Group included pregnant women from the third trimester. Hyperechogenic medullae were detected in 17 out of 82 pregnancies with intrauterine growth retardation. Results: Fetal renal hyperechogenicity appears to be an indicator of fetal arterial circulatory depression, correlated with pathological changes in the resistance index for the fetal renal arteries. The fetal renal arterial blood flow resistance index was significantly lower in hyperechogenic cases, while in the middle cerebral cerebral flow was in the normal range. This may also be an indication of subsequent intrauterine and neonatal complications, such as Cesarean section because of fetal distress (47%), treatment in a neonatal intensive care unit (71%) or increased perinatal mortality (12%). Conclusions: Detailed ultrasound of renal parenchyma and Doppler examination of renal and middle cerebral arteries appear to be a useful method in the prenatal diagnosis of reduced renal perfusion and of intrauterine hypoxia so as to detect possible pathological fetal conditions in utero.

outcome were significantly increased in infants with abnormal S/D ratio (P < 0.001). When logistic regression analysis was performed after adjusting for gestational age, the odds ratio for poor perinatal outcome was 3.7 in the group showing abnormal S/D ratio (95% confidence interval 1.42-9.54, P = 0.007). Conclusion: Umbilical artery Doppler velocimetry is shown as a significantly efficient method in predicting perinatal outcome in preterm neonates with small-for-gestational age, and it may be useful in managing preterm patients with small-for-gestational age fetuses. The results obtained in hypertensive patients: the incidence of fetal weight deficit at birth was 88.8% (25.9% the moderate form and 62.9% the severe form). The reliability of umbilical Doppler examination in the evaluation of fetal growth disorders was Se = 66.6%, Sp = 100%, PPV = 100%, NPV = 27.2%. A 15.5% error percent (8.6% false negative results and 6.9% false positive results) was obtained. P46.06 Evaluation of IUGR by umbilical Doppler examination Conclusions:In the presence of an ultrasound suspicion of IUGR, an abnormal umbilical RI value allows to confirm the alteration of fetal growth potential. A normal RI value in the context of IUGRE has a different significance depending on the presence or the absence of hypertension. P46.07Perinatal outcome according to umbilical artery blood flow velocity waveform of term pregnancies with small for gestational age pregnancies Ajou University School of Medicine, Republic of KoreaObjectives: To investigate whether umbilical artery blood flow velocity waveform is related to perinatal outcome of term pregnancies with small for gestational age. Methods: Total of 381 patients were at 37-41 weeks of gestational age who received antenatal umbilical artery Doppler blood flow and delivered singleton small-for-gestational age (SGA) infants. The ratio of peak-systolic to end-diastolic (S/D) blood flow velocities in the umbilical artery was measured in each patient. The patients were divided into a normal group (n = 307) with a S/D ratio equal to or less than 3.0, and an abnormal group with a S/D ratio of greater than 3.0 (n = 74). These groups were comparatively analyzed with respect to maternal characteristics and neonatal outcome. Results: There was no significant difference between the two groups with respect to mean maternal age, gestational age at the time of delivery, and Cesarean section rate due to fetal distress. There was significantly increased incidence of hypertensive disorders in pregnancy (12.3% vs. 25.0%, P = 0.005) and oligohydramnios (27.7% vs. 45.0%, P = 0.003) in the abnormal S/D ratio group. Significant difference was also observed between the two groups with respect to neonatal birthweight (2415.2 ± 258.9 vs. 2296.7 ± 325.0 g, P = 0.003), incidence of admission to neonatal intensive care unit (NICU) (27.0% vs. 51.3%, P < 0.001), and duration of NICU care (2.7 ± 5.9 vs. 5.7 ± 8.8 days, P = 0.005), but no difference was observed in terms of low Apgar score of less than 7 at 5 minutes (2.7%...