{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T23:16:58Z","timestamp":1790378218742,"version":"4.1.0"},"reference-count":35,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,5,8]],"date-time":"2020-05-08T00:00:00Z","timestamp":1588896000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Pregnancies complicated by late\u2010onset fetal growth restriction (FGR) are at increased risk of short\u2010 and long\u2010term morbidities. Despite this, identification of cases at higher risk of adverse perinatal outcome, at the time of FGR diagnosis, is challenging. The aims of this study were to elucidate the strength of association between fetoplacental Doppler indices at the time of diagnosis of late\u2010onset FGR and adverse perinatal outcome, and to determine their predictive accuracy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a prospective study of consecutive singleton pregnancies complicated by late\u2010onset FGR. Late\u2010onset FGR was defined as estimated fetal weight (EFW) or abdominal circumference (AC) &lt;\u20093<jats:sup>rd<\/jats:sup> centile, or EFW or AC &lt;\u200910<jats:sup>th<\/jats:sup> centile and umbilical artery (UA) pulsatility index (PI) &gt;\u200995<jats:sup>th<\/jats:sup> centile or cerebroplacental ratio (CPR) &lt;\u20095<jats:sup>th<\/jats:sup> centile, diagnosed after 32\u2009weeks. EFW, uterine artery PI, UA\u2010PI, fetal middle cerebral artery (MCA) PI, CPR and umbilical vein blood flow normalized for fetal abdominal circumference (UVBF\/AC) were recorded at the time of the diagnosis of FGR. Doppler variables were expressed as <jats:italic>Z<\/jats:italic>\u2010scores for gestational age. Composite adverse perinatal outcome was defined as the occurrence of at least one of emergency Cesarean section for fetal distress, 5\u2010min Apgar score &lt;\u20097, umbilical artery pH &lt;\u20097.10 and neonatal admission to the special care unit. Logistic regression analysis was used to elucidate the strength of association between different ultrasound parameters and composite adverse perinatal outcome, and receiver\u2010operating\u2010characteristics (ROC)\u2010curve analysis was used to determine their predictive accuracy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 243 consecutive singleton pregnancies complicated by late\u2010onset FGR were included. Composite adverse perinatal outcome occurred in 32.5% (95%\u2009CI, 26.7\u201338.8%) of cases. In pregnancies with composite adverse perinatal outcome, compared with those without, mean uterine artery PI <jats:italic>Z<\/jats:italic>\u2010score (2.23\u2009\u00b1\u20091.34 <jats:italic>vs<\/jats:italic> 1.88\u2009\u00b1\u20090.89, <jats:italic>P<\/jats:italic>\u2009=\u20090.02) was higher, while <jats:italic>Z<\/jats:italic>\u2010scores of UVBF\/AC (\u22121.93\u2009\u00b1\u20090.88 <jats:italic>vs<\/jats:italic> \u22120.89\u2009\u00b1\u20090.94, <jats:italic>P<\/jats:italic>\u2009\u2264\u20090.0001), MCA\u2010PI (\u22121.56\u2009\u00b1\u20090.93 <jats:italic>vs<\/jats:italic> \u22121.22\u2009\u00b1\u20090.84, <jats:italic>P<\/jats:italic>\u2009=\u20090.004) and CPR (\u22121.89\u2009\u00b1\u20091.12 <jats:italic>vs<\/jats:italic> \u22121.44\u2009\u00b1\u20091.02, <jats:italic>P<\/jats:italic>\u2009=\u20090.002) were lower. On multivariable logistic regression analysis, <jats:italic>Z<\/jats:italic>\u2010scores of mean uterine artery PI (<jats:italic>P<\/jats:italic>\u2009=\u20090.04), CPR (<jats:italic>P<\/jats:italic>\u2009=\u20090.002) and UVBF\/AC (<jats:italic>P<\/jats:italic>\u2009=\u20090.001) were associated independently with composite adverse perinatal outcome. UVBF\/AC <jats:italic>Z<\/jats:italic>\u2010score had an area under the ROC curve (AUC) of 0.723 (95%\u2009CI, 0.64\u20130.80) for composite adverse perinatal outcome, demonstrating better accuracy than that of mean uterine artery PI <jats:italic>Z<\/jats:italic>\u2010score (AUC, 0.593; 95%\u2009CI, 0.50\u20130.69) and CPR <jats:italic>Z<\/jats:italic>\u2010score (AUC, 0.615; 95%\u2009CI, 0.52\u20130.71). A multiparametric prediction model including <jats:italic>Z<\/jats:italic>\u2010scores of MCA\u2010PI, uterine artery PI and UVBF\/AC had an AUC of 0.745 (95%\u2009CI, 0.66\u20130.83) for the prediction of composite adverse perinatal outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>While CPR and uterine artery PI assessed at the time of diagnosis are associated independently with composite adverse perinatal outcome in pregnancies complicated by late\u2010onset FGR, their diagnostic performance for composite adverse perinatal outcome is low. UVBF\/AC showed better accuracy for prediction of composite adverse perinatal outcome, although its usefulness in clinical practice as a standalone predictor of adverse pregnancy outcome requires further research. Copyright \u00a9 2019 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.20406","type":"journal-article","created":{"date-parts":[[2019,7,25]],"date-time":"2019-07-25T15:40:18Z","timestamp":1564069218000},"page":"793-798","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":105,"title":["Role of Doppler ultrasound at time of diagnosis of late\u2010onset fetal growth restriction in predicting adverse perinatal outcome: prospective cohort study"],"prefix":"10.1002","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5525-4353","authenticated-orcid":false,"given":"G.","family":"Rizzo","sequence":"first","affiliation":[{"name":"Division of Maternal Fetal Medicine, Ospedale Cristo Re Universit\u00e0 di Roma Tor Vergata  Rome Italy"},{"name":"Department of Obstetrics and Gynecology The First I. M. Sechenov Moscow State Medical University  Moscow Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"Mappa","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine, Ospedale Cristo Re Universit\u00e0 di Roma Tor Vergata  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V.","family":"Bitsadze","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine, Ospedale Cristo Re Universit\u00e0 di Roma Tor Vergata  Rome Italy"},{"name":"Department of Obstetrics and Gynecology The First I. M. Sechenov Moscow State Medical University  Moscow Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"S\u0142odki","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences The State University of Applied Sciences in P\u0142ock  P\u0142ock Poland"},{"name":"Department of Prenatal Cardiology Polish Mother's Memorial Hospital Research Institute  Lodz Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Khizroeva","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine, Ospedale Cristo Re Universit\u00e0 di Roma Tor Vergata  Rome Italy"},{"name":"Department of Obstetrics and Gynecology The First I. M. Sechenov Moscow State Medical University  Moscow Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Makatsariya","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology The First I. M. 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