Hematologic profile of neonates with growth restriction is associated with rate and degree of prenatal Doppler deterioration.
OBJECTIVE
To examine the relationship between hematologic parameters at birth and prenatal progression of Doppler abnormalities in fetal growth restriction (FGR).


METHODS
The study was a secondary analysis of FGR patients (abdominal circumference < 5th percentile and umbilical artery pulsatility index (UA-PI) elevation) with at least three examinations prior to delivery. Prenatal progression was classified as rapid, moderate or slow based on the interval between diagnosis and delivery and the extent of UA, middle cerebral artery and ductus venosus Doppler abnormalities. Associations between diagnosis-to-delivery interval, Doppler Z-scores, progression and hematologic parameters at birth were examined.


RESULTS
Of 130 patients, 54 (41.5%) had rapid, 51 (39.2%) moderate and 25 (19.2%) slow deterioration, delivering within 4, 6 and 9 weeks of diagnosis, respectively. The strongest association of moderate and rapid deterioration was with a low platelet count (r2  = 0.37 and 0.70, respectively; P < 0.0001). In patients with moderate deterioration, platelet count correlated inversely with UA-PI (ρ = -0.44, P = 0.001) and was lowest when end-diastolic velocity was absent. With rapid progression, platelet count correlated inversely with nucleated red blood cell count (ρ = -0.51, P < 0.001) but no longer with UA-PI.


CONCLUSIONS
Our observations suggest a relationship between prenatal clinical progression of FGR and hematologic abnormalities at birth. Accelerating cardiovascular deterioration is associated with decreased platelet count, which can be explained by placental consumption or dysfunctional erythropoiesis and thrombopoiesis.
Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD 21201, USA. abaschat@umm.edu
A A
AA
Baschat
M
M
Kush
C
C
Berg
U
U
Gembruch
K H
KH
Nicolaides
C R
CR
Harman
O M
OM
Turan
D000293:Adolescent; D000328:Adult; D001724:Birth Weight / Q000502:physiology*; D005260:Female; D005317:Fetal Growth Retardation / Q000097:blood / Q000000981:diagnostic imaging*; D006801:Humans; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D010920:Placenta / Q000503:physiopathology; D010922:Placenta Diseases / Q000503:physiopathology; D010976:Platelet Count; D011247:Pregnancy; D011673:Pulsatile Flow / Q000502:physiology*; D012307:Risk Factors; D018608:Ultrasonography, Doppler / Q000379:methods; D016216:Ultrasonography, Prenatal / Q000379:methods; D055815:Young Adult