OC207: In utero therapy for congenital diaphragmatic hernia

Objective: The purpose of this study was to evaluate the clinical value of the uterine artery color Doppler at 23 week’s gestation in predicting adverse perinatal outcomes in unselected population. Methods: Uterine artery Doppler assessment was carried out at 22–25 week’s gestation in singleton pregnancies attending routine antenatal care. The mean pulsatility index (PI) was calculated and the predictive value of an average PI above 95th centiles in the detection of poor outcome was determined. Results: Transvaginal color Doppler examination was performed in 1350 consecutive singleton pregnancies and a complete outcome information was obtained in 1110 (83%) pregnancies. The median PI was 1.02 and the 95th centile was 1.57. Poor outcome, defined as preeclampsia, fetal growth restriction (FGR), abruption placenta and preterm delivery before 34 week’s, occurred in 143 (12.9%) pregnant women. The incidence of preeclampsia and FGR was 4.6% and 5.2%, respectively. The sensitivity of the mean PI above 95th centile for poor perinatal outcome was 26%, and for preeclampsia was 33%. Although, there were few cases with adverse perinatal outcome born before 35 week’s in our series (20 cases with just 6 preeclamptic pregnancies), the respective sensitivities for total adverse outcome and preeclampsia requiring delivery before 34 week’s was 45% (9 out of 20 cases) and 67% (4 out of 6 cases), respectively. Conclusions: Transvaginal uterine artery Doppler using as a screening test between 22–25 week’s identifies most of the pregnant women who develop severe adverse perinatal outcomes before 34 week’s of gestation. Supported by Fondecyt No 1020080.