Cervical condition and fetal cerebral Doppler as determinants of adverse perinatal outcome after labor induction for late‐onset small‐for‐gestational‐age fetuses

Abstract

(OR, 2.43; 95% CI,

Predictive accuracy of cerebroplacental ratio for adverse perinatal and neurodevelopmental outcomes in suspected fetal growth restriction: systematic review and meta‐analysis

“…The mean or median interval between CPR measurement and delivery was < or ∼48 h in five studies, ≤ 7 days in six studies, 7–14 days in three studies, > 14 days in five studies, 1–30 days in one study and unreported in two studies. Most studies ( n = 16) used the last CPR result before delivery in analyses. Sixteen studies reported that the CPR results were not used to manage the pregnancies, one reported that they were used to manage the pregnancies and the remaining five studies did not report on this issue.…”

“…Of 1191 citations identified initially, 22 studies, including a total of 4301 women/fetuses, met the inclusion criteria (Figure ). Two studies were performed using the same cohort, one reporting results for all cases of suspected FGR and the other for cases of suspected early‐onset FGR.…”

“…Most studies ( n = 16) used the last CPR result before delivery in analyses. Sixteen studies reported that the CPR results were not used to manage the pregnancies, one reported that they were used to manage the pregnancies and the remaining five studies did not report on this issue. Eleven studies provided data on the predictive accuracy of CPR for a composite of adverse perinatal outcomes, nine for admission to the NICU, seven for Cesarean delivery for non‐reassuring fetal status, six for perinatal death and 5‐min Apgar score < 7, five each for neonatal acidosis and neonatal brain lesions, four for neonatal morbidities other than brain lesions, two for SGA at birth and one for use of mechanical ventilation.…”

“…The definitions of suspected FGR used in the studies were as follows: EFW < 10 th percentile for GA (11 studies) 44,45,47,50,54,[56][57][58][59]62,64 , EFW < 10 th percentile for GA and/or abdominal circumference (AC) < 5 th percentile (two studies) 60,61 , EFW < 10 th percentile for GA and abnormal UA Doppler indices (two studies) 53,63 , AC < 5 th percentile for GA and abnormal UA Doppler indices (two studies) 46,49 , AC< 10 th percentile for GA (one study) 43 , AC < 10 th percentile for GA on at least two consecutive measurements, 2 weeks apart (one study) 55 , EFW < 10 th percentile for GA with growth rate slower than normal and abnormal UA Doppler indices (one study) 48 , EFW or AC < 10 th percentile for GA and abnormal UA Doppler indices (one study) 52 , and EFW below the GA-adjusted mean value minus 2 SD (2.3 rd percentile) or a fall of ≥ 10% weight deviation from the mean weight between two ultrasound examinations (one study) 51 . Ten studies reported results for suspected late-onset FGR 47,50,51,54,[56][57][58][59]62,63 , four for suspected early-onset FGR 47,56,58,61 and 14 for suspected FGR at all GAs [43][44][45][46]…”

Cerebro‐placental ratio – Is it time to start putting it to use?

“…10 Prior et al showed that using a cut-off of <0.6765 MoM yielded a similar positive predictive value for caesarean section because of presumed fetal compromise as using the 10th centile. 11,13,[16][17][18] When evaluating CPR in appropriately grown fetuses, recent reports used data from healthy post-term pregnancies. 13 More recent studies agree that the sensitivity of CPR in cases with IUGR measured before 34 weeks was higher than in the overall population.…”