Bridging the notch: quantification of the end diastolic notch to better predict fetal growth restriction

Abstract

Purpose We aimed to evaluate several quantitative methods to describe the diastolic notch (DN) and compare their performance in the prediction of fetal growth restriction.

Materials and Methods Patients who underwent a placental scan at 16–26 weeks of gestation and delivered between Jan 2016 and Dec 2020 were included. The uterine artery pulsatility index was measured for all of the patients. In patients with a DN, it was quantified using the notch index and notch depth index. Odds ratios for small for gestational age neonates (defined as birth weight <10th and <5th percentile) were calculated. Predictive values of uterine artery pulsatility, notch, and notch depth index for fetal growth restriction were calculated.

Results Overall, 514 patients were included, with 69 (13.4%) of them delivering a small for gestational age neonate (birth weight<10th percentile). Of these, 20 (20.9%) had a mean uterine artery pulsatility index >95th percentile, 13 (18.8%) had a unilateral notch, and 11 (15.9%) had a bilateral notch. 16 patients (23.2%) had both a high uterine artery pulsatility index (>95th percentile) and a diastolic notch. Comparison of the performance between uterine artery pulsatility, notch, and notch depth index using receiver operating characteristic curves to predict fetal growth restriction <10th percentile found area under the curve values of 0.659, 0.679, and 0.704, respectively, with overlapping confidence intervals.

Conclusion Quantifying the diastolic notch at 16–26 weeks of gestation did not provide any added benefit in terms of prediction of neonatal birth weight below the 10th or 5th percentile for gestational age, compared with uterine artery pulsatility index.

Zusammenfassung

Ziel Unser Ziel war es, verschiedene quantitative Methoden zur Beschreibung des diastolischen Notchings (DN) zu evaluieren und deren Leistung bei der Vorhersage einer fetalen Wachstumsrestriktion zu vergleichen.

Material und Methoden Eingeschlossen wurden Patientinnen, bei denen zwischen der 16. und 26. Schwangerschaftswoche eine Plazenta-Untersuchung durchgeführt wurde und die zwischen Januar 2016 und Dezember 2020 entbunden hatten. Bei allen Frauen wurde der Pulsatilitätsindex der A. uterina gemessen. Bei Patientinnen mit DN wurde dieses mittels Notch-Index und des Notch-Tiefenindex quantifiziert. Es wurden Odds-Ratios für SGA-Neugeborene (small for gestational age: Geburtsgewicht <10. und <5. Perzentile) berechnet. Die prädiktiven Werte der Pulsatilität der A. uterina, des Notch-Index und des Notch-Tiefenindex für fetale Wachstumsrestriktion wurden berechnet.

Ergebnisse Insgesamt wurden 514 Patientinnen eingeschlossen, von denen 69 (13,4%) ein SGA-Neugeborenes (Geburtsgewicht <10. Perzentile) zur Welt brachten. Von diesen hatten 20 (20,9%) einen durchschnittlichen Pulsatilitätsindex der A. uterina, der über der 95. Perzentile lag, 13 (18,8%) hatten ein unilaterales Notching und 11 (15,9%) ein bilaterales Notching. Sechzehn Frauen (23,2%) hatten sowohl einen hohen Pulsatilitätsindex der A. uterina (>95. Perzentile) sowie ein diastolisches Notching. Die Leistung des Pulsatilitätsindex der A. uterina sowie des Notch- und des Notch-Tiefenindex bezüglich der Vorhersage einer fetalen Wachstumsrestriktion (<10. Perzentile) wurde mittels der ROC-Kurve (receiver operating characteristic curve) verglichen. Die Werte für die AUC (area under the curve) betrugen 0,659 (PI der A. uterina), 0,679 (Notch) bzw. 0,704 (Notch-Tiefenindex), mit jeweils überlappenden Konfidenzintervallen.

Schlussfolgerung Die Quantifizierung des diastolischen Notchs in der 16.–26. Schwangerschaftswoche brachte im Vergleich zum Pulsatilitätsindex der A. uterina keinen zusätzlichen Nutzen in Bezug auf die Vorhersage eines Geburtsgewichts unterhalb der 10. oder 5. Perzentile.

Keywords

pulsatility index - uterine artery - fetal growth restriction - end diastolic notch

Publication History

Received: 11 August 2023

Accepted after revision: 31 January 2024

Accepted Manuscript online:
31 January 2024

Article published online:
29 April 2024

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