458: Impact of in utero transfusions in fetuses with hydrops fetalis due to alpha thalassemia

Abstract

proper management protocol for these women is still a matter of debate. One management tool is the placental scan. We aimed to evaluate the utility of this tool in women with abnormal FTS analytes. STUDY DESIGN: Retrospective cohort study of all women who had FTS and delivered at a single referral center (2016-2018). FTS included PAPP-A, PlGF, free b-hCG and AFP. Placental sonographic assessment included morphologic description of the placenta, fetal growth estimation and measurement of the average uterine artery pulsatility index (UtA-PI). All women with abnormal FTS analytes had a placental scan. All women who had abnormal morphology of the placenta during the scan and/or mean UtA-PI >95% percentile for gestational age were excluded. We compared pregnancies of women with abnormal first trimester analytes and normal placental scan (study group) with those who had normal first trimester analytes (control). RESULTS: Overall, 6,514 women were included in the study, of which 343 (5.3%) comprised the study group. Women in the study group were characterized by a younger mean maternal age, and higher rates of IVF treatment and gestational hypertension (Table). Women in study group were almost twice as likely to have a preterm birth (PTB)< 37 weeks, and their neonates' mean birthweight was lower (Table). Nonetheless, the rate of FGR was similar between the groups (Figure). On multivariable logistic regression, women in the study group were more likely to have gestational hypertension [aOR 1.9 (95% CI 1.1-3.3)], and PTB< 37 weeks (aOR 2.1, 95% CI 1.4-.3.1), mainly due to abnormal PAPP-A [aOR 2.71 (1.44-5.11)]. Yet, their neonates were not at higher risk for FGR< 3rd, 5th, or 10th percentile [aOR 0.45 (95% CI 0.2-1.2), aOR 1.1 (95% CI 0.7-1.8) and aOR 1.1 (95% CI 0.8-1.5), respectively]. CONCLUSION: Following a normal placental scan, women at risk for FGR based on the FTS analytes do not have higher risk for FGR than their counterparts with normal FTS analytes.