Cardiovascular changes and neonatal outcome in IUGR fetuses born to normotensive and preeclamptic mothers

24–28 August 2008, Chicago, USA Oral poster abstracts Cardiovascular changes and neonatal outcome in IUGR fetuses born to normotensive and preeclamptic mothers E. Cosmi1, E. Funai1, S. Rusconi1, MD Piga2, G. Bogana1, C. Saccardi1, S. Visentin1, V. Berghella3, E. Ferrazzi4, S. Rigano4, A. Serena1 1Gynecological Science and Human Reproduction, University of Padua School of Medicine, Padua, Italy, 2Obstetrics and Gynecology, University of Sassari, Sassari, Italy,, 3Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, United States, 4Department of Obstetrics and Gynecology, University of Milan, IRSCC, Milan, Italy Objectives: To assess the cardiovascular changes in IUGR fetuses with isolated placental insufficiency versus IUGR associated with preeclampsia by Doppler ultrasonography, cardiotocography and BPS and to compare neonatal outcome. Methods: A prospective matched control multicentric study of 220 IUGR fetuses (abdominal circumference <5th percentile; increased umbilical artery pulsatility index). Among these, 110 fetuses were IUGR from normotensive women and 110 associated to maternal preeclampsia. Doppler velocimetry of UA, MCA, DV, evaluation of amniotic fluid index was performed twice weekly and cardiotocography and BPS daily. Delivery was performed <32 weeks if there were signs of fetal compromise (BPS <4 or cardiotocographic alterations), or maternal indications for preeclampsia. Perinatal mortality and composite morbidity (5 min. Apgar, RDS, BPD, ROP, IVH, PVL, and NEC) was recorded and correlated with Doppler parameters. Results: Among 220 IUGR fetuses, in IUGR fetuses of normotensive mothers mean gestational age at delivery was 29.3 °æ 1.8 weeks, and mean birth weight was 939.7 °æ 164.9gr. In IUGR fetuses associated to maternal preeclampsia mean gestational age was 28.8 °æ 2 weeks, and mean weight at birth 878.9 °æ 262.4 gr. The temporal sequence of IUGR fetuses associated to preeclampsia show an earlier onset of Doppler alterations compared to IUGR fetuses of normotensive mothers. Considering neonatal outcome, in IUGR fetuses of normotensive mothers the morbidity, mortality and fetal death was higher compared to IUGR from preeclamptic women. Conclusions: The present study highlights that IUGR fetuses should be divided into two entities: isolated IUGR due to placental vascular insufficiency and IUGR fetuses associated to maternal preeclampsia. This distinction is essential to manage these fetuses since IUGR fetuses without maternal preeclampsia develop cardiovascular compromise in a longer period of time compared to IUGR fetuses from preeclamptic women.