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OP01.01: Second trimester growth restriction and underlying fetal anomalies

Objectives: To determine the incidence of chromosomal abnormalities, syndromic association and fetal defects in second trimester fetal growth restriction (FGR) in a tertiary referral center for prenatal diagnosis. Methods: Retrospective review of all cases referred between 14 and 27 weeks with an abdominal circumference (AC) < 5th centile between 2008 and 2012. The presence of aneuploidy and associated malformations was also assessed. Multiple pregnancies were excluded. Results: A total of 8626 fetuses had ultrasonographic examination between 14 and 27 weeks. Of these, there were 239 cases (2.8%) with evidence of FGR. Thirty-seven fetuses had an abnormal karyotype or an identified syndromic association (15%), 67 had at least one morphological abnormality without aneuploidy or syndromic association (28%), 135 cases were isolated fetal growth retardation (57%). The most common chromosomal defect was Trisomy 18. Most common morphological abnormalities were relative short femur (5%), omphalocele (5%) and gastroschisis (4%). The Maternal age was higher (33 yr ± 5 yr versus 31 yr ± 5, 6 yr, P = 0.007) and the z-score for the AC lower (2.5 ± 1 versus 2.15 ± 0.6) in the group with abnormal karyotype or syndromic association than in the group without malformation. Amniotic fluid was more often increased in the group with an abnormal karyotype or associated malformation (14% and 17%) than in the group without malformations (0%, P = 0.0003 and 0.0001). Conclusions: This study describes abnormalities and outcomes associated with second trimester fetal growth retardation in a large population of patients referred for that purpose. Our results suggest that the degree of growth restriction, maternal age and the amniotic fluid index may help in the prenatal management and counseling of this high risk population.