P46.05: Umbilical artery Doppler study as a predictive marker of perinatal outcome in preterm pregnancies with small for gestational age

Abstract

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.