Poster Session 3
Category: Antepartum Fetal Assessment
Poster Session 3
Madeline J. Pence, MD (she/her/hers)
Department of Women’s Health, Dell Medical School at the University of Texas at Austin
Austin, Texas, United States
Anna Madden-Rusnak, PhD (she/her/hers)
Research Scientist
Department of Women’s Health, Dell Medical School at the University of Texas at Austin
Austin, Texas, United States
Jermiah Crowder, BS
Medical Student
Dell Medical School at the University of Texas at Austin
Austin, Texas, United States
Madeline Petrikas, BS
Medical Student
Dell Medical School at the University of Texas at Austin
Austin, Texas, United States
Kobina Ghartey, MD
Assistant Professor
Department of Women’s Health, Dell Medical School at the University of Texas at Austin
Austin, Texas, United States
Alison G. G. Cahill, MD, MSCI
Assoc. Dean, Translational Research; Prof, Women’s Health; Dir, Health Transformation Research Inst.
Department of Women’s Health, Dell Medical School at the University of Texas at Austin
Department of Women’s Health, Dell Medical School at the University of Texas at Austin, Texas, United States
Lorie M. Harper, MD (she/her/hers)
Associate Professor
Department of Women’s Health, Dell Medical School at the University of Texas at Austin
Austin, Texas, United States
Velamentous cord insertion (VCI) is associated with fetal growth restriction (FGR); ACOG recommends antenatal testing starting at 36 weeks (w) but does not make recommendations on growth surveillance. The purpose of this study was to evaluate the timing of ultrasound surveillance in patients with VCI.
Study Design:
Retrospective cohort of singleton pregnancies diagnosed with VCI < 24w at a single center from 9/2021-5/2025. Pregnancies complicated by chronic hypertension, diabetes, BMI≥ 35 kg/m2, or age ≤ 16 or ≥ 40 years were excluded. Subsequent growth ultrasounds were excluded after patients developed gestational diabetes or pregnancy-induced hypertension. Outcomes considered were diagnosis of FGR (estimated fetal weight (EFW) or abdominal circumference (AC) < 10%ile) or oligohydramnios (amniotic fluid index (AFI) ≤ 5cm). We calculated the number needed to screen (NNS) and 95% confidence interval (CI) to identify one abnormality for scans that were performed at a gestational age of 24-31w6d and ≥ 32w.
Results:
Among 65 patients with isolated VCI meeting inclusion criteria, 151 additional ultrasounds were performed, and the majority received >1 ultrasound for growth surveillance (38% received two, 38% received ≥3, Figure 1). Two cases of FGR were diagnosed in total, both ≤ 32w (Table 1). Chart review demonstrated both cases of FGR were diagnosed at 30-31w and persisted through delivery. The NNS to diagnose one case from 24-31w6d was 26.5 (95%CI: 7.7-217.2). No cases of oligohydramnios were diagnosed. No new cases of FGR were diagnosed after 32w, suggesting that the risk of FGR is not higher than 5%, based on the calculation (1-Maximum Risk)n=0.05.
Conclusion:
Among patients with isolated VCI, few cases of FGR were diagnosed, and were diagnosed at 30-32w. Therefore, if an ultrasound surveillance screening protocol for patients with VCI is used, a single ultrasound at 30-32w to evaluate growth is likely sufficient, followed by antenatal testing beginning at 36w per ACOG recommendations.